Coaching Orientation Form

This Coaching Orientation Form is aimed to help me better understand your values and goals so I can guide you on your path to success!

(All personal information is strictly confidential and will not be shared outside of Janice Otremba Coaching & Consulting.)

Client Information

Full Name

Mailing Address:

Start Date

City

Province

Postal Code

Email:

Home Phone

Work Phone

Company

How long have you been at your current place of employment?

Marital Status:

Cell Phone

Best number to reach you at:

Position

Children? Pets? Other significant people in your life?

Birthday

Client Questionnaire

Imagine yourself at the end of your life looking back. What would you need to do / see / experience in order to say you lived a fulfilling life with few or no regrets?

Take time to reflect on your passions. What are they? Where in your life do they show up? Where don't they show up? If you were to tell me one secret passion, one that is almost too exciting to do or do more of, what would it be?

What's missing in your life, the presence of which would have your life be more fulfilling?

The work we do together is deeply connected to your values system and is shaped by your world view. With this in mind, what are your religious or spiritual beliefs? Do you believe in a higher power? If so, what words would you use to describe this belief? How do you express this in your life? Use as little or as much detail as you feel comfortable with.

What does success mean to you?

What are you tolerating in your life?

What generally keeps you from getting what you want?

Who is your favourite movie heroine/hero and what do you admire about them?

What would you like me to know in order to be the best possible coach for you? What tips could you give me to coach you most effectively?

Rate each category on a scale of 0-10

Money

Family / Friends

Fun / Recreation

Physical Environment (i.e. Home, Work, etc. )

Career

Personal Growth

Health

Romance / Significant Other

Values Clarification: What are your top 3 values?

Goals

Goal 1:

Preferred Completion Date:

Goal 2:

Preferred Completion Date:

Goal 3:

Preferred Completion Date:

Anything else you wish to include?

Coaching Orientation Form

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