Life Coaching Client Data Form

Please complete the client data form.

Surname:___________________________ First Name:__________________

Age:___________(yrs.) Occupation:_________________________________

Address:________________________________City:____________________

Prov./State:________________________Postal/Zip Code:_______________

Email Address:______________________________

Website Address:____________________________

Residence Phone:___________________Business Phone:________________

Cell Phone:_________________________

Preferred means of communication:__________________________________

Preferred coaching schedule:_______________(day of wk)_________(time)

How did you hear about my life coaching services?

What influenced your decision to work with a life coach?

Have you ever been coached? If so, please describe the experience.

Do you have specific goals for the coaching relationship? If not, what goals might you now create?

What are your significant commitments?

What would your perfect look like?

What are your dreams?

What dreams have you given up on?

Where do you want to focus first?

What parts of your life are working best now?

What parts of your life are working least well?

What stops you from having the life you want to have?