Name:

Date of Birth:

Email:

Address:

Phone Number:

Occupation/ Employer:

1. What do you hope to achieve by working with a coach?

2. Are there factors that might get in the way of you achieving these outcomes?

3. Who is with you on the journey? Who do you take care of and who takes care of you?

4. What are you proud of (past and present)?

5. What does success mean to you and how have you experienced it?

6. What are some things that bring you joy?

7. What can you expect of me as your coach? What can I expect of you?

8. What kind of accountability is helpful to you? What is not helpful?

9. Is there any information that you would like me to know about your identity and/or life experiences (cultural, gender, professional, religious, etc.) that will help me understand you and your background?

10. What will your life look like, feel like, or sound like when we're finished working together?

Anything else that you'd like me to know before we get started?