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1:1 Coaching Intake Form

Please complete this short intake form before our first session. Your responses will help me better understand your goals, challenges, and how to best support you during our time together. Even if we discussed some of these topics during our discovery call, your written reflections provide valuable insight and allow us to hit the ground running.

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Question 1 of 10

What inspired you to seek coaching at this time?

Question 2 of 10

What would you like to focus on?

(Select all that apply)
A

Gaining clarity about my next steps in life or career

B

Overcoming fear, doubt, or self-sabotage

C

Improving confidence and self-worth

D

Managing stress or emotional overwhelm

E

Rewiring limiting beliefs and thought patterns

F

Creating healthier habits and routines

G

Navigating a life transition (personal or professional)

H

Deepening self-awareness and spiritual alignment

I

Setting and achieving aligned goals

J

Building emotional resilience

K

Reconnecting with my authentic self

Question 3 of 10

How would you describe your current mindset?

A

Focused

B

Overwhelmed

C

Ambitious

D

Scattered

E

Anxious

F

Hopeful

Question 4 of 10

What would success look like for you at the end of our work together? 

Question 5 of 10

What’s one thing you know needs to change, even if you're not sure how yet?

Question 6 of 10

What are the biggest challenges or blocks you're currently facing? 

Question 7 of 10

How do you best receive support or feedback?

A

Direct

B

Gentle

C

Collaborative

D

Challenge-based

Question 8 of 10

What beliefs or habits do you feel may be holding you back? 

Question 9 of 10

Are there any topics you would prefer NOT to focus on? (optional) if so please list them below. 

Question 10 of 10

Is there anything else you'd like me to know to support you fully? 

Confirm and Submit