About You

About you
(This form is only to be filled in once we have arranged our initial session. All information will be dealt with confidentially)

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone number with international code *

Email *

Website *

Occupation (what you do to earn a living) *

Next of Kin *

Next of Kin phone number (only used in emergencies) *

How did you hear about this service? *

If you are here by recommendation, please enter their name and email address so that I can show my gratitude. *

Initial Questions

To prepare for our first meeting, please take time to ponder and then answer the following questions.
They are intended to begin the process or inquiry, reflection, learning and forward movement.
But firstly...

What is / are your main goal(s) that you hope coaching can help you with? *

About your Life and Career

1. What are you most proud of? *

2. What has been your biggest disappointment? *

3. How would you describe your satisfaction with your life direction so far? *

4. What words describe how you feel about your career? *

5. What is the compliment or acknowledgement you hear most often about yourself? *

6. What dream of yours is still unfulfilled? *

7. What words describe you at best? *

8. What words describe you when you are at less than your best? *

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

10. Imagine you can have one wish fulfilled. What one thing would you change? *

About Coaching You

1. What will make this coaching relationship rewarding for you? *

2. What approaches encourage or motivate you? *

3. What approaches discourage or de-motivate you? *

4. How will you know you are receiving value from this coaching relationship? *

5. What else would you like me to know about you? *

Thank you for taking the time.

Submit

The PERMA Profiler is a test that measures the five pillars of well-being: https://permahsurvey.com/

You can also find more test from Penn State's University on Authentic Happiness here: www.authentichappiness.sas.upenn.edu/testcenter

You can use these to keep track of your overall well-being and more. We will also be using some of these in our sessions, depending on your requirements and to evaluate effectiveness.

Member of:
UKATA -
UK Association of Transactional Analysis

I welcome LGBTQ+ clients

Statement of Ethical Practice
I conduct myself personally and professionally according to the highest standards of honesty and integrity and always hold the best interests of my clients as paramount and in strict confidence. I continuously strive for excellence in our coaching relationship and do not more outside the limits of my knowledge and expertise. I am a member of the International Coach Federation and abide by their Code of Ethics.

Personal Information Fact Sheet

About you(This form is only to be filled in once we have arranged our initial session. All information will be dealt with confidentially)

Initial Questions

About your Life and Career

About Coaching You

Thank you for taking the time.

About you
(This form is only to be filled in once we have arranged our initial session. All information will be dealt with confidentially)