Coaching Application

Ready to communicate more clearly and confidently?

Coaching Application

Ready to communicate more clearly and confidently?

Coaching Application

Ready to communicate more clearly and confidently?

Professional Coaching Application

I look forward to seeing if working with you is your next right step. Please submit the form below at least 2 days before your appointment.

Your information will be kept completely confidential.

Instructions

Please take the time to answer ALL of the questions below. Some of the questions capture information about where you are today, while others will get you thinking about what you want from coaching or/and for your business, and for life in general. This information will set a good foundation and allow us to move forward to help you achieve your goals.

NOTES:

1) Please give yourself 20-30 minutes to fill out the application. Your application may NOT be saved if you walk away from it, so we suggest that you finish it in one sitting.

2) Questions in red and marked with an * are mandatory questions and cannot be left blank. Questions in black and without the * are optional to answer, so please answer them as they apply to you.

Questions?

If you have any questions about the application, you can email me at ann@4better4ever.com or reach out to me via Facebook.

Professional Coaching Application Form

First Name*

Last Name*

Email Address*

Phone*

Address*

1. What do you hope to gain from the coaching relationship?*

2. If you knew you couldn’t fail, what would you do and what would your life be like?*

3. If all your dreams came true, what kind of person would you become?*

4. What do I need to know about you?*

5. What are you most proud of in your life?*

6. What are your 3 biggest accomplishments in your life? *

7. What do you have to contribute that is unique?*

8. What skills or knowledge do you have?*

9. What do you do when you are really up against it?*

10. What activities have meaning and heart for you?*

11. What are your growth objectives in the next 6 months?*

12. What can I say or do when you get stuck, to return you to action?*

13. What 2 steps could you take immediately that would make a difference for your current situation?*

14. How can I best support you as your coach?*

15. What is the main objective you want to accomplish from our coaching relationship?*

16. a) How would you describe your overall mood over the past 3 months? (choose the best option)*

16. b) Please explain your answer for 16. a)

17. a) Have you ever seen a professional (doctor, psychologist, pastor, therapist, etc) for ANY type of mood disorder? Ex; depression, anxiety, etc.* 17. a) Have you ever seen a professional (doctor, psychologist, pastor, therapist, etc) for ANY type of mood disorder? Ex; depression, anxiety, etc.* Yes No

17. b) If yes, please explain and please include if you are currently seeking any kind of treatment (either professional or alternative) for any type of mood disorder.

18. a) Over the past 3-6 months, have you had ANY suicidal thoughts?* 18. a) Over the past 3-6 months, have you had ANY suicidal thoughts?* Yes No

18. b) If yes, please explain.

19. a) Are you currently suffering from any physiological challenges? If yes, please explain. 19. a) Are you currently suffering from any physiological challenges? If yes, please explain. Yes No

19. b) If yes, please explain.

20. a) Have you had an affair in the past year?* 20. a) Have you had an affair in the past year?* Yes No

20. b) If yes, please explain.

21. a) Do you have any active addictions?* 21. a) Do you have any active addictions?* Yes No

21. b) If yes, please explain.

22. What medications are you currently taking?*

15 + 5 =