Coaching Journeys, LLC

Client Data Form - Confidential

Congratulations on taking another step toward coaching! The following information is requested prior to your first official coaching session. Please take as much space as necessary to complete the following information and return it to me before our first coaching session. This does not constitute an agreement to coach. Coaching is subject to your acceptance of the Coaching Agreement. Thank you.

Date prepared:
    Full name:
    Nick name:
      Company:
      Address:
         City:
        State:Zipcode:
    Day phone:Eve phone:
   Cell phone:Fax:
        Email:
Date of birth:
  Referred by:
Desired start date:
   Occupation:
Nature of business/position/speciality:

Hobbies/interests:

How would you best describe WHO you are?

What as a coach should I know about you?
This would include any information that could enhance our
coaching relationship or give me an idea of how best to coach you. 

What, if anything, could possibly get in your way?
(physical or emotional health issues, money issues, 
time issues, addictions, family issues, fear of success, etc.)   

What are the three (3) most important goals 
you would like to reach in the next 90 days?


I agree that all the above is true and correct and am ready to move to the next step.  
   Please contact me by e-mail to schedule my first session.