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Welcome to Coaching!

I am delighted we will be working together.  Coaching is about you as a whole person: your values, your work, your personal exploration and direction.  Through the process, clients typically reach their goals, deepen their awareness and knowledge and enhance their quality of life.  I work with motivated individuals like you as they develop their own definition of success.

Please spend some time with this questionnaire giving it thoughtful attention.  It is meant to spark your thought process and it will begin to set the foundation we’ll be working from. Please submit this questionnaire prior to our first session to give me a better idea about you and what your goals are.

    Contact Information

    Your Name (required)

    Your Email (required)

    Phone

    What is the best way for me to reach you?
    PhoneEmailTextOther

    How would you prefer to have our sessions conducted? Please include in the space below what your username is in the selected platform.
    SkypeFaceTimeTelephoneIn-Person

    Address

    Referred By

    Personal Information

    Date of Birth

    Name and list the important people in your life:

    Describe your work and your level of satisfaction with it:

    When not at work, how do you fill your days?

    What are your unique gifts?

    Strengths are tasks or actions that you do well - abilities, talents or skills. What are your top four?

    Values are important beliefs or ideals. What are your top four values?

    What activities are meaningful for you?

    What are your top accomplishments? (Things you have worked on or completed that you are the most proud of)

    Health Information

    What physical activities do you regularly participate in?

    On a scale of 1 to 10 (with 1 being very unsatisfactory and 10 being very satisfactory), please rate your level of:

    Aerobic Activity
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Flexibility
    1
    2
    3
    4
    5
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    8
    9
    10
    Mobility
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Strength
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Ability to Relax
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Sleep
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Diet
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    Please indicate your level of consumption of:

    Alcohol
    NoneLightMediumHeavy

    Caffeine
    NoneLightMediumHeavy

    Tobacco
    NoneLightMediumHeavy

    Water
    NoneLightMediumHeavy

    Goals

    What brings you to coaching?

    A person's quality of life is made up of different elements. Of the eight listed, please rate 1-10) your current satisfaction with the following areas? Make sure this is your satisfaction, not society's

    Health
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Career
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Financial
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Family & Friends
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Fun & Leisure
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Personal Developent
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Other
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    What are your top three health and wellness goals?

    Why are these important to you?

    What type of support motivates you?

    What do you see as the biggest obstacles to achieving your goals?

    What additional information do you think I should know?

    The client is aware that Natalie Carroll Wellness is not a medical professional or psychological counselor/therapist. The goal of Natalie Carroll Wellness is not to diagnose or treat medical conditions but to help the Client explore lifestyle opportunities to improve quality of life. Results cannot be guaranteed. The Client agrees that he/she is entering into coaching and/or classes understanding that the Client is responsible for their own decisions and results. Natalie Carroll Wellness makes requests, offers observations and shares intuitive hunches that may be helpful in facilitating your ongoing forward momentum. Natalie Carroll Wellness is an equal partner in designing your action plan. When Natalie Carroll Wellness makes a recommendation for an action, you always have the power to stop and renegotiate your action strategy. The Client also agrees to hold Natalie Carroll Wellness free from all liability for any actions or results for adverse situations created as a direct or indirect results of a referral or other advice given by Natalie Carroll Wellness.

    I acknowledge that I have read and accept the terms and conditions stated above.

    Signature:

    Dated: