Client Intake Form for Life Coaching
To be prepared by client prior to the first session with me. Many thanks.
Name of client:
Mobile:
Email:
Background for your coaching experience. About you and your style.
1. What have been your three
biggest milestones in your
life?
2. What is your home
structure?: family, partner,
important others, animals
3. How do you spend your
leisure time?
4. What do you want to be
doing (or what changes
would you like) in 6 months
time?
5. What three changes might
be necessary in your life
over next few months?
6. How ready do you feel to
tackle these changes?
7. What might be your
purpose(s) in life do you
think?
8. What are four words that
you, or others, would
describe you at your best?
Intake form for Executive Coaching
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9. What four words would
describe you when you are
tired and stressed?
10. Results/scores of any self
awareness tools you have
undertaken eg MBTI, TMI,
DISC, HBDI etc
11. What’s the hardest thing
you have had to manage or
overcome?
12. What are your normal
coping strategies? How do
you stay resilient?
13. In what circumstances do
you feel most settled,
balanced and at peace with
the world?
14. In what circumstances do
you feel at your most
creative?
15. How do you feel about this
transition/time in your life?
List all the feelings.
16. What is your stress/
depression/ anxiety level
now? (Scale 1-10, with 10
being very high)
17. Who are the people you
need to support you
through any change? Who
is your positive cheer
squad? Who provide you
with ‘nutritious’ support?
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18. What part of yourself, if
anything, have you stopped
working on?
Working life
19. Brief details of your work
background and/or current
position or latest personal
development activities?
20. What do you find/have you
found most enjoyable at
work; what motivates you at
work?
21. If relevant, describe your
team style or leadership
and management style.
22. How do you react to
authority?
23. How well do you
communicate and
influence? What social
skills are you good at?
24. What are you learning about
yourself at this point of
your life?
Other concerns for self
25. When was your last break
or holiday?
26. What sort of inner dialogue
do you have going on? If
negative self talk what is it?
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27. What are the range of
options you have ruminated
on about what comes next
for you – in terms of work,
study, relationships?
28. How have you been at
taking care of yourself?
29. What further learning or
skills development have
you wanted to do? Work or
pleasure.
30. Have you ever suffered
from anxiety or depression?
Medications?
31. Do you like self assessment
tools to encourage self
awareness?
32. What is your preferred
learning style? Eg Action,
theory, experimenting,
reading or reflection?
33. What have been your
obstacles to learning in the
past?
34. How can I, as coach, best
help you? – e.g. how would
you like me to keep you on
track, what would you like
me to do if you are getting
behind in your goals and
intentions?
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Other?
Other information – assessment tools you might like to try for free:
Professor Martin Seligman (author of Learning Optimism and Authentic Happiness) says there are
three ways to live your life with the third way being the key to a contented life:
1. A pleasurable life – having fun, buying things, parties, being with people
2. An engaged life – using your ‘strengths’ for yourself; being ‘in the flow’ at work and home
3. A meaningful life – using your ‘strengths’ in the service of others
To identify your top five strengths: Dr Seligman’s VIA Signature Strengths Questionnaire can be found
at University of Pennsylvania website: http://www.authentichappiness.sas.upenn.edu
This is a free questionnaire. After registering on the site your results will be used anonymously for
continuous research. Dr Seligman has raised over $100m for research into positive psychology – one
of the foundations for successful coaching.)
Thank you for completing this.
It will make our time together most productive!
Intake form for Life Coaching
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