Coaching Intake Questionnaire

Please fill out this form to help me get to know you and understand how I can best support you in our coaching work together. This is not a test, and there are no right or wrong answers—answer honestly and to the degree you feel comfortable. Your responses will help us shape a coaching relationship tailored to your goals.

You can also look at the Coaching page to get ideas of what you might want to work on together!

Full name

Pronouns and gender identity

Phone

Address

Time zone

Emergency contact name, relationship to you, phone, and email

What are your top goals for coaching? Do you want to work on writing, publishing, ADHD, and/or career coaching?

How would your life look or feel different if we successfully achieve these goals?

Have you worked with a coach, therapist, or other helping professional before? What worked well for you, and what didn’t?

What are your biggest strengths?

What tends to get in your way when working toward goals?

What motivates you most? What discourages you most?

Is there anything else you'd like me to know before we begin?

How did you hear about me or connect with me?

Today's Date

Month

Day

Year

By signing below, you confirm that the information provided is accurate to the best of your knowledge.

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Author, Therapist, Coach

Coaching Intake Questionnaire

Free Worksheet: Spot Healthy vs. Toxic Relationships
Sign up and instantly get the free handout!

Coaching Intake Questionnaire

Free Worksheet: Spot Healthy vs. Toxic Relationships Sign up and instantly get the free handout!

Free Worksheet: Spot Healthy vs. Toxic Relationships
Sign up and instantly get the free handout!