Preliminary Assessment

The following questionnaire is designed to save both yourself and us time and effort.

Despite its lengthy format and extensive array of questions, you will find it helpful and informative – regardless of whether you pursue the coaching option.

We will use this questionnaire to evaluate our ability to help you. All information will be kept confidential and will be destroyed should either party decide not to proceed.

You will be offered coaching if:

  • There is a 100% chance that we can assist you to reach the goals and targets you outline below,
  • There is a place available and
  • That there is an excellent “match”.

We will be transparent with you about this and will make the time available to establish a professional working relationship or explain our reason(s) for not proceeding.

Contact Details

Full Name :
Primary email:
Number & Street:
Town/Suburb:
Postcode:
Phone wk:
Phone hm:
Mobile:
Age:
Married/Single/Other: (how long?)
Occupation/Business: (how long?)
Children: (sex & age)
Your Birth Order: (eg: 2nd of 3)
Education:
How Did you Hear About Us?

Questions

Take as much space as is necessary, the page will automatically extend and more explanation/detail is better.

Habits I want to eliminate...

Repeating patterns in my life I want to change are...

Parts of my life I feel "stuck" in are...

I am considering using a coach because...

I have been thinking this way for...

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

My most important matter to resolve as a result of the coaching process is...

The most important goal/target I want to reach is...

Other goals/targets I want to reach are...

I have not been able to reach this/these targets so far because...

I also have a specific need for...

Your coaching would be a good "fit" for me because...

Previous coaches/mentors...
(i.e. list person/organisation, what you gained and why they were a great coach/metor)

My Strengths...

My Weaknesses...

Turning Points in My Life...

If I were to proceed, the most valuable aspect of the coaching process would be...
(support, accountability, direction, focus, validation,
challenge, motivation etc.)