Starting your coaching journey begins with understanding your goals and needs. Our Life Coach Client Intake Form helps us learn about your background, priorities, and the areas of life you’d like to grow in—whether it’s career, relationships, or personal development. Completing this form allows your coach to create a personalized plan to help you achieve meaningful and lasting results.

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At Heart & Mind Counseling Services, our professional life coach uses this information to tailor sessions that foster clarity, motivation, and accountability on your path to success.

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1. What do you want to work on in this coaching relationship? List up to 3 focus areas.

 

2 What type of feedback have you received recently from supervisors, peers, direct reports, friends, or family members (in these focus areas)?

 

3. What will success look like for you? Ninety days from now, how will you know whether you have achieved your goal(s)?

 

4. How does your short-term focus relate to where you see yourself in the longer term (5-10-20 years)?

 

5. How must you change to achieve your short and long-term goal(s)?

 

6. What do I need to do as your coach to help you achieve your goal(s)?

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7. What do you think could get in the way of me helping you change to achieve your goals?

 

8. What are your core values? What do you care about most?

 

9. How would you describe your personality? (Please share your Myers-Briggs type with me or other assessments such as Emergenetics, StrengthsFinder, DiSC, etc. if known.)

 

10. What are your strengths? What are you best at?

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11. If you get stuck while we are working on something, what can I say or do to get you unstuck?

 

12.  What else should I know to be able to coach you effectively?

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This form was developed by ICF-Certed Coach Christopher Dietz. Permission to use this form must be granted by Coach Dietz.