Intake Questionnaire
All responses will be kept confidential and will not be shared with any other party, person or company.
Please answer all questions honestly.

Coachee Intake Assessment

Name

First Name

Last Name

What would you like to get out of coaching?

Please describe your professional role (company, position, areas of responsibility, number of employees you manage, work long hours, etc)?

What motivates you?

How do you tend to sabotage yourself?

How do you best learn?

How do you release stress?

What do you do to look after yourself on a regular bases?

What are your strong points?

What are your week points?

What have you given up on in life?

When were you happiest in your life?

When were you unhappiest in your life?

If you could have anything in the world, what would it be?

What do you want the rest of your life to be about?