Intake Questionniare | Awake Yourself

Take some time to answer the following questions. The better I know you, your situation, and your expectations, the better I can help you.

Intake Questionnaire

First Name

Last Name

Phone

How did you hear about us?

Relationship & family situation: marital status/relationship history, number of children, etc:

Career & work situation: role, business, education, etc:

Personal information: DOB, birth order, etc:

Are you doing this coaching on your own accord or is someone else involved? (e.g., employer, partner)

Why is now the right time for a coaching? (flash-point, reason, cause, pressure, wish)

What have been the key factors that made you decide to start a coaching? Are they internal (wish for improvement, change, development) or external (changing circumstances or pressure from outside, from other people)?

Are you committed to the sessions and the homework and the challenges necessary to change your mindset and situation?

Thanks for submitting! We’ll get back to you shortly.