Solutions Life Coaching

Name:

DOB:               

Gender:  M / F

Marital Status:

Spouse/Partners Name:

Address:

City:

State:

Zip:

Home Phone:

Mobile Phone:

Best Time to Call:

Type of Employment:

Hours per Week:

What are the top three things you would like to accomplish working with a coach?

From the top three things listed above, which one seems to be the hardest to accomplish?

Which one of these three things do you wish to accomplish the most?

What attempts have you made to accomplish your priority goal?

With the assistance of a life coach, how long do you think it will take to accomplish this goal?

How would accomplishing this goal change your life?

What expectations do you have of your life coach?

Do you have any questions or comments you would like your coach to address?