Coaching Form

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Coaching Program

Personal and Contact Information

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Full Name

Preferred Name

Date of Birth

Phone number

Email Address

Address

Emergency Contact

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Name

Relationship

Phone number

Background Information

1. Occupation

2. Company/Organization (if applicable)

3. How did you hear about our coaching program?

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4. Have you ever worked with a coach before? (Yes/No)

Goals and Expectations

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1. What motivated you to seek coaching at this time?

2. What specific goals do you hope to achieve through coaching?

3. What do you see as your biggest challenges in achieving these goals?

4. How will you know when you have achieved your goals?

Personal Insights

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1. What are your core values and beliefs?

2. Describe your strengths and areas of improvement?

3. What are you passionate about?

4. What are some of your hobbies or interests?

Current Situation

1. On a scale of 1-10, how would you rate your current satisfaction in the following areas:

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Career

0 / 10

Relationships

0 / 10

Health

0 / 10

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Personal Development

0 / 10

Financial Situation

0 / 10

2. Briefly explain the reasons behind your ratings.

Logistics and Preferences

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1. Preferred coaching session frequency

(e.g., weekly, bi-weekly)

2. Preferred coaching session duration

(e.g., 30 minutes, 1 hour)

3. Preferred method of communication for sessions

(e.g., phone, video call/zoom)

4. Best days and times for coaching sessions:

Social Media Information (Optional)

To help us understand you better and build a stronger coaching relationship, you may choose to share your social media profiles. This information is optional and will be used solely for the purpose of getting to know you better.

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Instagram

Facebook

Other

Additional Information

Is there anything else you would like to share or any questions you have before we begin?

Signature and Agreement

By signing below, I confirm that the information provided is accurate to the best of my knowledge and that I am committed to actively participating in the coaching program.

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Signature

Clear Signature

Date

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