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Life coaching client application
Please complete this questionnaire in full and I will follow up with you shortly to talk more about how I might be able to help you. You can find all of my coaching costs and packages on my website:
http://www.angiegibbons.com/coaching
Name
Your answer
Email address
Your answer
Phone number
Your answer
Emergency contact name and relationship to you
Your answer
Emergency contact phone number
Your answer
May Angie leave a voicemail on this number related to your coaching?
Yes
No
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May Angie text appointment reminders to this number?
Yes
No
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Preferred coaching format
Phone call only
Zoom call with video
Other:
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Occupation
Your answer
Date of birth
MM
/
DD
/
YYYY
Relationship status
Single
In committed relationship
Married
Divorced
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Children and ages (if applicable)
Your answer
Names of other important people in your life (partner, close family members and friends)
Your answer
How did you hear about my coaching services?
Your answer
Have you ever been to coaching or counseling before? If so, please tell me a little about your experience.
Your answer
Do you have any specific goals in mind for our coaching sessions?
Your answer
If you were to wake up tomorrow and your life was improved, what would be different about it?
Your answer
What gets in the way of you having the life you want?
Your answer
What are your strengths?
Your answer
What are your weaknesses?
Your answer
What are you most passionate about?
Your answer
Tell me a little about your spiritual journey.
Your answer
What else about your life is important for me to know about you? For example, accomplishments, dreams, highlights, major events.
Your answer
Tell me a little about your life satisfaction. This is not meant to bring shame but to offer you a chance to give an honest personal assessment so we can see how each category changes over time. Rate yourself on a scale of 1 to 10 in each area with 10 being Completely satisfied and 1 indicating Plenty of room for improvement.
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Physical health
Emotional health
Spiritual health
Family
Finances
Career
Social relationships
Time & schedule
Learning/growth
Recreation/fun
1
2
3
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5
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7
8
9
10
Physical health
Emotional health
Spiritual health
Family
Finances
Career
Social relationships
Time & schedule
Learning/growth
Recreation/fun
Clear selection
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