HOME .Form Client Info Form Client Information Form "*" indicates required fields 1Contact Information2Personal Information3Employment Information4Coaching Questions5Life Balance 6Values & Virtues Client Information FormName* Email* Mobile Phone*Work PhoneAddress Best Contact MethodMobile PhoneTextEmailWork PhoneOther Personal InformationBirthday DD slash MM slash YYYY Marital StatusSelectSingleCommitted RelationshipMarriedDivorcedWidowedSpouse/Significant Other's Name Date Married DD slash MM slash YYYY Number of Children Names & Ages of Children Spiritual LifeSelectActiveNot ActiveNo AffiliationSpiritual AffiliationSelectNot AffiliationChristian – CatholicChristian – OrthodoxChristian – ProtestantAgnosticAthismBuddhismConfucianismDiasporic AfricanGnosticismHinduismIslamJainismJudaismKabbalahNative AmericanShintoSikhismTaoismTraditional AfricanYazdânismYogaZoroastrianism Employment InformationOccupation Employer Name Length at Current Employer Length in Industry Job Satisfaction 1 2 3 4 5 6 7 8 9 10 Coaching QuestionsWhat is your biggest goal for coaching? How will we know if we are successful? What is your preferred coaching schedule? (day of week and time) Whit is your preferred meeting method? Zoom Video Phone Call What influenced your decision to work with a coach? Have you ever been coached? If so, please describe the experience: What are your significant commitments? What would your perfect life look like? What dreams have you given up on? Where do you want to focus first? Life Balance On a scale of 1 to 10 (10 being PERFECT), rate the following…Health / Self-Care 1 2 3 4 5 6 7 8 9 10 Social / Fun 1 2 3 4 5 6 7 8 9 10 Personal / Spiritual Development 1 2 3 4 5 6 7 8 9 10 Career / Business 1 2 3 4 5 6 7 8 9 10 Family & Friends (Community) 1 2 3 4 5 6 7 8 9 10 Finances 1 2 3 4 5 6 7 8 9 10 Romance / Intimacy 1 2 3 4 5 6 7 8 9 10 How You See YourselfOn a scale of 1 to 10 (10 being PERFECT), rate how the following resembles you…1. Decisive, adventurous, direct, risk-taker, assertive, self-reliant 1 2 3 4 5 6 7 8 9 10 2. Optimistic, persuasive, emotional, charming, sociable, impulsive 1 2 3 4 5 6 7 8 9 10 3. Accurate, analytical, tactful, sensitive, systematic, precise 1 2 3 4 5 6 7 8 9 10 4. Consistent, cooperative, deliberate, patient, loyal, composed 1 2 3 4 5 6 7 8 9 10 LET'S TALK ABOUT WORKThe key to successful leadership is influence not authority GET STARTED
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