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Coaching Intake Form
Date of Birth
Field of Study
Best Times to Reach You
What three goals would you like to accomplish within the next three months or for this intervention?
What one major goal would you like to accomplish within the next twelve months?
What has been your greatest challenge in relation to your goals?
What do you expect to achieve as a result of hiring me as your coach?
On a scale of 1 to 10 (10 as high), rate the quality of your
There are ways of coaching clients, the below is just some. Which one/s appeal to you? (tick relevant)
󠄖Brainstorming strategies together󠄖 󠄖
󠄕Insight into who you are
󠄖Accountability; checking up on goals
󠄕Suggesting/ designing action steps
󠄕Support, encouragement and validation
󠄖Painting a vision of what you can accomplish
󠄕Exploring/removing blocks to your success
Any additional comments
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