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Coaching Intake
This form is used by coaches at BOLDLY at the commencement of a coaching engagement. This form does not constitute the Agreement, however works in addition as an expectation setting and prep-work tool. The content collected here is confidential between the coach and coachee. This form may take 15-30 minutes to complete, depending on your level of detail and reflection.
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* Indicates required question
My first name is:
*
Your answer
My coach's first name is:
*
Your answer
I understand that coaching is not therapy, and that my coach will seek to refer me to an appropriate professional if needed.
*
Agree
Required
My current mental health status includes (click all thoughts, feelings and behaviours that apply - please note that none of these symptoms preclude you from undertaking coaching):
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Feelings of anxiety or depression
Drug & alcohol use
Weight changes
Trouble sleeping
I'm currently undergoing therapy or counselling
I have previously undergone therapy or counselling
None of the above
Required
I understand that coaching is confidential, except in situations where my coach believes I, or someone close to me, may be at risk of harm.
*
Agree
Required
I understand that if at any stage I am concerned about the conduct of my coach, I can email
connect@boldly.app
*
Agree
Required
I will be motivated and committed to the coaching process by preparing for each session and undertaking the agreed actions after each coaching session.
*
Agree
Required
My initial goal for coaching relates to (summarise your issue, ideal outcome, and any steps you've already taken to achieve it. High level is OK - you will work closely with your coach on this through your sessions to hone your goal):
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Your answer
I believe my character strengths include (click all that apply):
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Creativity
Curiosity
Open-mindedness
Love of Learning
Perspective and Wisdom
Bravery
Persistence
Integrity
Vitality
Love
Kindness
Social intelligence
Being an active citizen who is socially responsible, loyal, and a team member.
Fairness
Leadership
Forgiveness and mercy
Humility and modesty
Prudence
Self-Regulation and Self-control
Appreciation of beauty and excellence
Gratitude
Hope
Humor and playfulness
Spirituality, or a sense of purpose
Required
I will be keeping the following people abreast of my coaching engagement (list all sponsors, stakeholders, supporters by first name only - please note, your coach will not be making contact with these people):
*
Your answer
I have completed a psychometric assessment or 360 review in the past 18 months:
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Yes
No
I believe this coaching experience will be successful if... (finish the sentence)
*
Your answer
Thank you! To further prepare for your coaching engagement, we recommend you have a dedicated note book set aside for your in-session notes and post-session homework and reflections. You might further prepare by considering your goal, and what your ideal future state will look like. Thanks for working with us!
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