MINETUM CLIENT INTAKE FORM

(Pre-Coaching Questionnaire)

Thank You!

Thank you for taking the time to complete the Intake Form. I look forward to reviewing your responses before our first coaching session. Your answers will help me better understand your goals, current situation, and how I can best support you throughout our coaching journey. If you have any questions before we begin, please don’t hesitate to reach out. I look forward to working with you!

Full Name

Address

Phone

Date of birth

LinkedIn URL

Academic Background

Occupation

How did you find me?

Tell me about yourself

Tell me about your current situation and your biggest challenges

What have you already done so far to work on this?

What do you want to achieve by working with a coach?

What are your top three goals for the next 3–6 months?

What strengths do you believe will help you achieve your goals?

On a scale of 1–10, how confident do you currently feel about achieving your goals? Why?

What is most important to you in your career and life right now?

Imagine you’ve completed our coaching program and you’re thrilled with the outcome. What has changed?

On a scale of 1–10, how committed are you to achieving your goals over the next three months? Why? (1 = Not very committed, 10 = Fully committed)

Is there anything that might prevent you from fully committing to this coaching process?

What would make this coaching experience a success for you? How can I best support you throughout the process?

Is there anything else you would like me to know before we begin working together?