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Home
About
About
Tri-Fold Brochure
1:1 Coaching Services
Life & Leadership Coaching
Business Coaching
Business Consulting
Executive Mentoring
Christian Life Coaching
Free Session
Code of Ethics
Resources
Forms
Contact Info Form
2 Page Brochure
Tri-fold Brochure
Contact Us
Call 503-803-8873
Contact Information
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Contact Information
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Personal Information
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Employment Information
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Coaching Questions
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Life Balance
6
Values & Virtues
Client Information Form
Name
*
Email
*
Mobile Phone
*
Work Phone
Address
Best Contact Method
Mobile Phone
Text
Email
Work Phone
Other
Personal Information
Birthday
DD slash MM slash YYYY
Marital Status
Select
Single
Committed Relationship
Married
Divorced
Widowed
Spouse/Significant Other's Name
Date Married
DD slash MM slash YYYY
Number of Children
Names & Ages of Children
Spiritual Life
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Active
Not Active
No Affiliation
Spiritual Affiliation
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Not Affiliation
Christian - Catholic
Christian - Orthodox
Christian - Protestant
Agnostic
Athism
Buddhism
Confucianism
Diasporic African
Gnosticism
Hinduism
Islam
Jainism
Judaism
Kabbalah
Native American
Shinto
Sikhism
Taoism
Traditional African
Yazdânism
Yoga
Zoroastrianism
Employment Information
Occupation
Employer Name
Length at Current Employer
Length in Industry
Job Satisfaction
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Coaching Questions
What 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
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Social / Fun
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Personal / Spiritual Development
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Career / Business
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Family & Friends (Community)
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Finances
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Romance / Intimacy
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How You See Yourself
On a scale of 1 to 10 (10 being PERFECT), rate how the following resembles you...
1. Decisive, adventurous, direct, risk-taker, assertive, self-reliant
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2. Optimistic, persuasive, emotional, charming, sociable, impulsive
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3. Accurate, analytical, tactful, sensitive, systematic, precise
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4. Consistent, cooperative, deliberate, patient, loyal, composed
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