New Coaching Client Questionnaire

Please fill out this form so that I have a basic understanding of you and your needs.

The more information you provide, the more effective I can make the coaching sessions.

I will review this information before our first session.

Name *
Name
Sex *
How would you describe your occupation?
How much do you expect to earn this year?
How would you describe your diet over the last two weeks?
How much physical activity do you usually get in a normal week?
How would you describe your fitness level?
How would you describe your normal sleep patterns over the last month?
Have you ever been in therapy before? Are you in therapy now? If you stopped therapy, why did you stop?
What would you like to tell me about your use of substances? (Including even coffee, tobacco and prescription drugs.)
What do you estimate your IQ to be?
What would you like to tell me about your sexual history? Have you ever lived with someone your were in a sexual relationship with?
How tall are you?
How much do you weight?
Is there anything about your religious beliefs or history that you would like to share?
How would you describe your family and childhood?
What do you expect from the coaching process? With what do you want help?