New Client Questionnaire CONTACT INFORMATION Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * How would you like to stay in touch between sessions? * I will contact you daily, Monday-Friday, although you are welcome to message me whenever you want. I will reply during business hours. *Marco Polo is a free video messaging app. Text Email iMessage Marco Polo* PERSONAL INFORMATION All of these questions are optional. It helps me to get to know you better! Your Birthday MM DD YYYY Spouse/SO Name First Name Last Name Anniversary Date MM DD YYYY Education GED/HS Diploma Some College 4-Year Degree Post-Graduate Degree Current Occupation Children Names and Ages Pets COACHING QUESTIONS What made you decide to hire a coach at this time? Have you had coaching in the past? If yes, please describe your experience. What are your top three challenges right now that need immediate attention? What outcomes would you like to see at the end of 3 months? What are your top 5 strengths? What do you feel most passionate about or inspired by? On a scale of 1 to 10, with 10 being the highest, where do you rate your self-care right now? What has been one of the biggest things you've had to overcome in your life? Is there anything in addition that I should know about before our first meeting? Thank you for filling out the “New Client Questionnaire,” all of the information provided will help in building a strong coaching relationship!
