New Customer Intake Form

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Personal & Employment Details

Full Name*

Preferred Name or Nickname

Phone

Preferred method of communication

Company/Organization Name

Company/Organization Industry

Size of the Company/Organization

(e.g., number of employees)

Your Current Job Title/Position

Briefly describe your current role and responsibilities

How long have you been with this company/organization?

Background & Professional Development

How many years have you been in your current position?

How many years have you been in the professional world?

Have you received any leadership or professional development training in the past?

Yes

Please describe

Have you ever taken any psychological or personality assessments such as Clifton Strengths, Caliper, DISC, Myers-Briggs, or any others?

Yes

Please list them and email them to me with this document.

For any assessments you've taken, can you share your results or key takeaways?

Coaching Goals & Challenges

Why are you seeking business confidence and leadership coaching currently?

What are your top three goals you hope to achieve through coaching?

What are the biggest challenges you face in your current role?

Describe a recent situation where you felt you lacked confidence or leadership skills

Self-Assessment

On a scale of 1-10, how would you rate your current level of confidence in your professional role?

Please enter a number from 1 to 10.

On a scale of 1-10, how would you rate your current leadership skills?

Please enter a number from 1 to 10.

What strengths do you believe you bring to your role?

In which areas do you feel you need the most growth or improvement?

Professional Relationships & Company Dynamics

Describe your relationship with your immediate supervisor

How would you describe the dynamics of your team or department?

Are there any specific individuals or groups within the company/organization you'd like to build a better relationship with?

Learning & Communication Style

How do you prefer to receive feedback (e.g., direct, with examples, written, verbal)?

Describe a past coaching or mentoring experience. What worked well for you? What didn’t?

How do you best learn and process new information?

Logistics & Preferences

How often would you like to meet for our coaching sessions?

This list provides a comprehensive view of your background, current situation, goals, and preferences, setting a solid foundation for your coaching relationship.

Would you like to receive our Newsletter?

Yes

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Phone

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