Coaching Client Info Form | stephanieellis

Name

Street Address

Date of Birth

Today's Date

Phone

State/Country/Zip

Relationship Status

Names of important people and pets in your life (partner, kids [with ages], parents, siblings, etc.):

Why are you choosing to work with a coach? How can I be most helpful to you?

Have you ever worked with a coach before? If yes, please describe the experience:

What three goals would you like to accomplish within the next three months?

What’s one major goal you’d like to accomplish within the next twelve months?

How is your health?

What are the problems or challenges you’re facing now?

What do you value most in your relationships?

Do you use the Rituals for Living Dreambook? If yes, for how long?

What are your core values (if you know them)?

What are your top five gifts/strengths (if you know them)?

What is your life purpose (if you know it) and what does living your life purpose look like to you?

If you’re not sure of your life purpose, what needs in the world are you moved to meet?

How well do your current roles fit or not fit with your purpose and natural strengths?

Tell me about your vision for your future:

How do you most want to feel?

Do you feel confident in your ability to create whatever you want in your life?

How is the quality of your sleep, and how many hours do you usually get?

How do you feel about your body?

How would you rate your energy (without caffeine) on a 0 to 10 scale, where 0 means totally exhausted and 10 is full of energy?

What major changes have taken place in your life in the last year?

What do you consider your role to be in your local community? In your country? In the world?

What do you enjoy doing in your free time?

Do you exercise regularly? What do you do to move your body?

What do you believe in?

What do you do when you’re really up against an obstacle or barrier?

What has been your greatest challenge?

If there were nothing holding you back, what would you do with your life?

How do you feel about your connection to nature?

Any additional questions or comments:

Thanks for submitting! Please know that everything you share on this form and throughout our work together will be kept strictly confidential.