Learning with Clarity LLC - Coaching Intake Questionnaire

First name

Last name

Phone

Address

Coach you will be working with

Multi choice

John George

Jen Dees

General Background

What motivated you to seek coaching support?

Have you worked with a coach, therapist, or counselor before? If yes, briefly describe your experience.

Are there specific areas or topics you would like to focus on? (e.g., mental health, substance use recovery, relationship challenges, personal growth)

Goals and Expectations

What are your top three goals for our coaching sessions?

How will you measure your progress toward these goals?

What do you hope to achieve through coaching in the short term (next 3-6 months)?

What are your long-term aspirations that coaching may help you achieve?

Challenges and Barriers

Are there any obstacles or barriers that you currently face in achieving your goals?

How have you tried addressing these obstacles in the past?

Are there specific behaviors, thoughts, or emotions that you find challenging to manage?

Support System and Resources

Who makes up your current support system?(e.g., family, friends, support groups, community services)

Are there any resources or tools you currently use to support your mental health or personal growth?

Commitment and Accountability

On a scale of 1-10, how committed are you to the coaching process and achieving your goals?

What do you need from your coach to feel fully supported and engaged in this process?

Additional Information

Is there anything else you would like us to know about you or your situation?

Do you have any questions or concerns about the coaching process?