INTAKE QUESTIONNAIRE

LET’S BEGIN OUR JOURNEY TOGETHER

The following questions will help me get to know you better and understand what you want from the coaching relationship. They are intended to be pondered and to stimulate your thinking in a way that will make our work together dynamic and prosperous. I invite you to carve out appropriate time for this and to take breaks if needed. Please send me your responses at least 24 hours before the first coaching session.

This questionnaire is designed to help you reflect on where you would like to be in specific areas and where you currently are. Please be honest with yourself; this isn’t an assessment. We will use this information as a starting point for reflecting and creating your coaching outcome together. This will allow us to connect the ideal life you want to create for yourself. Knowing what is in your heart and what is important to you is crucial to our work together.

Before you start working on this, feel free to take a few minutes to get quiet and connect with your highest vision. The work here is to connect within yourself, your intuition, your heart, and your deepest desires. We are looking for what is in season right now, not necessarily from what your mind or logic tells you. I invite you to create your intention from your intuition and heart, those visions that appear at your most authentic, clearest moments. Please be present when creating from your mind and logic vs. your heart and intuition.

For each of the areas below, consider what your ideal life would look like. Then, rate it from 1 to 10 and indicate your satisfaction.

1 = being very dissatisfied to 10 = being fully satisfied (Use the first number (score) that pops into your head, which may differ from what you think it should be.)

NOTE: We have given examples of a fulfilled life in each area to help you rate your satisfaction. However, please don’t limit yourself to these examples; instead, focus on what is important to you in that area and what called you to work with a coach. There is space below each location if you wish to say more.

Name:

First Name

Last Name

Date:

YYYY

AREA 1: Prosperity, Finances & Career:

What's your ideal situation?

You may yearn to expand your prosperity and livelihood and find a way of making money that aligns with your values. You are using and developing your gifts and who you came here to be. You want the resources you need to thrive and contribute to life.

AREA 2: Confidence & Authentic Power:

Who do you dream of being?

You may be feeling a deep yearning to be visible, seen, known, and show up with authentic confidence as being Fully yourself.

AREA 3: Love & Relationships

What does your ideal relationship look/feel like?

You may be yearning to attract and create growth-oriented relationships, where you are “met”– emotional, mental, physical, spiritual – and not just to come together in marriage and partnership to raise a family and create security, but for support to be fully who you came here to be. To be loved unconditionally for who you are and where you are fiercely supported to become the best version of yourself.

AREA 4: PURPOSE

What are you here to do / build / create?

You may be yearning to discover and cultivate your unique gifts and genius.

AREA 5: Creativity

What are your creative goals?

You may want to express your creativity, manifest your deepest desire for self-expression and FUN, and have outer spaces that reflect your inner possibilities.

AREA 6: Health

What are your health goals?

You may yearn to feel even more at home in your body, to be healthy, and to radiate vitality, feeling like you have access to boundless energy. Being able to step into an experience of physical thriving is to be the vibrant and alive person God intended you to be.

AREA 7: Spirituality

What are your spiritual development goals?

You may long to deepen your connection to a higher power and have a relationship with an intelligence, God, or energy bigger than yourself.

AREA 8: Influence

What is your desired impact?

You may feel a calling to impact and influence more people and uplift and empower those around you. You may have ideas or inspirations about how you can participate in making the world a better place in some way, no matter how large or small.

Main areas you would like to work on:

Pick the top 3 areas in which you felt the most the most connection and yearning.

Take a deeper dive into these 3 areas…

What would you like to feel, experience, express, and create in these areas of life? Consider exploring further by tapping into your senses—what would they feel, smell,  Taste, and look like? 

Set Your Goals:

Where are things today, and where would you like them to be? SMART GOALS: Make them Specific, Measurable, Achievable, Relevant, and Time-Bound. We can take time in the following sessions to clarify and explore.

What is it you most want to create in your life right now?

What would success look like for you?

What have been the most significant challenges affecting your life?

What are you desiring to overcome most?

What activities do you most enjoy doing?

What is fun & brings you the most joy?

Additional Info:

Is any there other background information relevant, such as work, health, relationships, etc. you would like me to know?