Coaching Intake Form Thank you for taking the time to answer these questions. In order for me to best support you, I will need to know more about you and your current situation. Please fill out this questionnaire and have it sent to me no later than 48 hours before our first session. Answer as truthfully and as descriptively as you can – the more honest you are, the better I can help support you and the better results you will receive! Don’t worry, what you share here is strictly confidential. Don’t think too much about the answers! The best answers are often what comes to mind first.Name* First Last Email* Enter Email Confirm Email What Time Zone are you in?* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 1) Please take the Enneagram test online. This test is incredibly accurate and helps us understand your emotional states and reactions from a deep psychological level. The test costs $12 and you can find it online at https://tests.enneagraminstitute.com . Have you taken it yet? 2) Tell me about the three biggest struggles you are currently having. On a scale of 0-10, rate them in severity of how much they are impacting your life.3) How would you know if you had overcome your struggles? What would that look like to you?4) What do you think your friends and/or family respect you for most? What do you think annoys them most about you? If you don’t know the answer to this (or even if you do), ask a few close friends/family members what they think and compare answers.5) Tell me a little about your childhood.6) What are you most ashamed of? Why?7) What is your greatest fear?8) When was the last time you put yourself out of your comfort zone?9) When in your life can you remember stepping up to the challenge and overcoming a struggle you had?10) What do you feel is your greatest accomplishment so far in your life? Why?11) Tell me about your work-life balance.12) Do you often put others’ needs above your own? Explain briefly.13) Tell me about your physical health.14) What do you currently do to alleviate stress?15) What do you do to reward yourself?16) What motivates you? What are you passionate about? What brings you joy?17) Who supports you in your life right now? How do you feel they support you?18) List your top 5 core values. Briefly explain why they are important to you.19) What are you most grateful for in life? Why?20) If you were to guess what the three things were that were holding you back from being where you want to be, what do you think they would be?21) If you could wave a magic wand and overcome these challenges, what would that look like?22) If you got the best results from this coaching experience, where would you see yourself in 6 months? 5 years? Who else would benefit from these changes?23) How committed are you to making the changes you feel you need to make?24) What is one step that you could take right now to move forward?Section BreakCAPTCHA Δ
