Pre-work Intake Questionnaire Please answer the following questions as thoroughly as possible. We can use this information in our work together.All of the information you provide is confidential. Name * First Name Last Name Email * Phone * (###) ### #### Address 1. Think back to when you were a child. Name 3-5 things that you loved and were good at. 2. As an adult, name 3-5 things you love doing and that you do well. 3. When was the last time you lost track of the time while doing something fun. Please describe what you were doing in as much detail as possible. 4. What have you always wanted to do and/or dreamed about? Did you give up on it? Why? 5. What would your dream be if you knew that you could not fail? 6. What would bring more meaning into your life? 7. What do you want people to say about you? What would make you feel proud? 8. What makes you happy? Content? 9. Pretend you have a magic wand that would allow you to do anything or change anything you want in your life. What would that be? 10. Here are some sentences for you to complete. Don’t give it a lot of thought, just answer the first thing that comes to mind: a) If I had more time I would... b) If I had more money I would... c) If I could change one thing about myself it would be... 11. What is your biggest fear? 12. Are you willing to commit to making changes that will bring you closer to your dreams? 13. What are you hoping to gain from coaching? What are your goals? Please be specific. Is there anything else you’d like to share? Please write as much as you’d like here: Thank you for taking the next step! I’ll
