Intake – Disability Mojo Coach

#DisabilityMojo Coaching Intake Form

Introduction

The questions in this form are designed to assist you in understanding what you would like to achieve through the coaching process.

This information is helpful for me to understand who you are and how I can best support you, your goals and what you want to achieve in your life.

My Coaching Approach

Complete the Intake Questionnaire

Step 1 of 5 - About yourself

Name
First Last
Postal Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell-phone*
Email*
Province & Home Town*
Age*
Gender*
Occupation*
Do you have a disability?*
Do you have a child/family member living with you who has a disability?*

Please describe your ideal lifestyle (how you live, where you live, with whom you live)?*
What are the most significant changes in your life/career/relationships you want to make over the next 3 years? What, if anything, is missing to achieve this?*
What would you say have been your 3 most significant accomplishments to date?*

Have you worked with a coach before?*
Why do you want to hire a coach?*
What do want to change in your life? What are you hoping the coaching process will achieve for you?*

Is your life one of your choosing? If not, which parts are being chosen for you?*
What is a dream or goal you have let go?*
What part of yourself, if any, have you given up on?*

Do you have a personal or professional vision? If so, what is it?*
What do you want your legacy to be?*
Is there anything else you would like to share with me at this point?*