Pre-Coaching Assessment FormPlease complete this form as the first step in helping determine whether coaching through the Talking Truth w/ Jaye program is right for you. Many people find that this exercise helps to structure their thoughts and get greater clarity about what they would like to achieve from coaching. Please don’t feel you have to complete all the questions, but give attention to the ones that particularly resonate with you. From the information you provide, I will develop a coaching proposal that is specific to your particular needs and will include time frames and cost. This no obligation proposal will be sent to you by email, and then you can decide whether or not to proceed.Contact DetailsFirst Name *Last Name *Phone Number *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail Address *Optional / Voluntary DataDate of BirthMarital StatusMarital StatusSingleMarriedDivorcedWidowedSpouse's or Significant Other's Name(if applicable)Children's Names & Ages(if applicable)OccupationConfidentialityOur coaching relationship is confidential. Unless you disclose issues, which your coach is required to disclose to the authorities (e.g. intent to harm yourself or others), all of the content of our conversations will be held in confidenceI accept this confidentiality policyPrevious Coaching/Counseling ExperiencesIn the past, have you worked with a Coach? If so, how long/what years?In the past, have you worked with a Therapist? If so, how long/what years?Major Issues AddressedHow was the coaching/counseling helpful?Work/Life BalanceHow would you rank your current level of satisfaction with each of the following areas of your life?WorkVery SatisfiedSatisfiedDissatisfiedEmotional HealthVery SatisfiedSatisfiedDissatisfiedPhysical health/well-beingVery SatisfiedSatisfiedDissatisfiedMental HealthVery SatisfiedSatisfiedDissatisfiedFinancesVery SatisfiedSatisfiedDissatisfiedSpirituality/religionVery SatisfiedSatisfiedDissatisfiedRelationship with spouse/significant otherVery SatisfiedSatisfiedDissatisfiedRelationship with childrenVery SatisfiedSatisfiedDissatisfiedRelationship with boss or co-workersVery SatisfiedSatisfiedDissatisfiedSocial network/self-esteemVery SatisfiedSatisfiedDissatisfiedSignificanceWhat are you like when you are at your best?What have you always wanted to do in life?What accomplishments must, in your opinion, occur during your lifetime so that you will consider your life to have been satisfying and well lived - a life f a few or no regrets?How do you most want to be remembered by those who are closest to you?How do you most want to be remembered by those who are closest to you?If you could devote your life to serving others - and still have the money and lifestyle you need - would yo do it? How would it look?What's missing in your life? What would make your life more fulfilling?Do you believe in God or in the concept of a higher power? If so, describe the most useful and empowering aspects of your relationship with God. If not, what reference point do you use?Goals/IntentionsWhat are your most important goals for the next 6 or 12 months?What, if anything, is standing in the way of you achieving your dreams/goals?What would you like to achieve from coaching?How would you like your coach to be? (e.g. demanding, gentle, challenging, etc.)What else would you like your coach to know about you and your current life situation?Did you find this form:Annoying - "Oh no, not another form"Helpful - "This form helped me to structure my thoughts and clarify my coaching objectives"Other - please commentThank YouFor the time you have taken to answer these questions and for your open and honest responses. You will receive a copy for your own reference sent to the email address provided above.CongratulationsOn taking the first step. Regardless of whether you decide to go ahead with any coaching, just by making contact and writing down your dreams and goals, you have already started to step into your preferred future. That's significant! Once your completed pre-coaching form has been received, I will get back to you with my recommended approach.Submit Assessment Form
