Preliminary Assessment

The following questionnaire is designed to maximise our time during your first coaching session.

If you are really stuck with a question, just write down that you don’t know; however, the more time you put into this, the more benefit you will get out of it.

All information will be kept confidential.

Your Name (required)

Your Email (required)

1) Habits I want to eliminate…

2) Repeating patterns in my life I want to change are…

3) Parts of my life I feel “stuck” in are…

4) I have decided to use a coach because…

5) I have been thinking this way for (time)…

6) I would like to gain clarity/understanding on the following issues...

7) My most important matter to resolve as a result of the coaching process is…

8) The most important goal/target I want to reach is…

9) Other goals/targets I want to reach are…

10) I have not been able to reach this/these targets so far because…

11) I also have a specific need for…

12) Previous coaches/mentors…
Specify:
• Person/organization…
• What I gained…
• He/she was a great mentor because…

13) My Strengths…

14) My Weaknesses…

15) Turning Points in My Life…

16) The most valuable aspect of the coaching process would be… (support, accountability, direction, focus, validation, challenge, motivation etc.)

To further support our initial discussion, please provide the following information:
Age: Gender:
Occupation:


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