NoorWorks Coaching Intake Form

Your Coach *

Client Name *

First

Last

Phone *

Email *

DOB *

Date of Birth

Occupation *

Your Agreement

To undertake coaching for a minimum of 6 sessions *

Yes
No

To share what I know about my own motivation and learning *

Yes
No

To share what my values are and what is important to me *

Yes
No

To co-design the structures which will support me *

Yes
No

To ask for changes when the strategies do not fit for me *

Yes
No

To challenge me with powerful questions *

Yes
No

To request that I take action When I identify that something is important to me *

Yes
No

To hold me for account for actions that I commit to *

Yes
No

To provide enquiries for me to think about *

Yes
No

For my time to be shortened accordingly, if I am running late for a session *

Yes
No

To reschedule my appointments 24 hours in advance *

Yes
No

To use the final session as the completion session *

Yes
No

All about you :

1. Describe your duties, roles and main areas of focus at work? *

2. Who are the key people in your work and private life (Name/Relationship)? *

3. What is important to you? *

4. What do you care about? *

5. What do you want in your life? *

6. What do you think your purpose in life is? *

7. What do you love doing? *

8. Are there any particular individuals you admire? Who are they and what is it about them you admire? *

Peak Experiences

9. When has life been rich, full, exhilarating, flowing? Pick a time. These may have been challenges but you were on a role. It may have been a few minutes, hours or weeks. What was important about that experience? *

10. What values were you honouring? *

Crazies

11. What drives you nuts or makes you angry or frustrated? Think about one of these things. *

12. What values are being violated? *

13. What is it that you can not live with and still be true to your self? (e.g. Being in a relationship where someone wants you to change) *

14. What is so much a part of you that you have not even thought about putting on this form? Other invisible values? *

15. List all the life skills you can think of which you possess. What are you especially good at? What do you do well in? Think of every context. Are you friendly? Optimistic? Do you facilitate well? Are you tidy? Do you have big visions? *

Please answer this question before moving on to the next question.

16. What are your unique abilities? Choose 10 – 15 words from this list that stand out as your unique abilities. *

Discovery your Purpose

17. What are you most proud of having done or accomplished in your life? *

18. If you were independently wealthy and did not have to worry about income, what would you choose to be doing right now in your life? *

19. What would you most like to be remembered for/as? What would you hope others would say about you? *

20. If you have a wish which would solve a worldly problem, what would it be and why? *

21. What do you believe your purpose is in life? If you do not know, what would it be if you could choose anything? *

Take the time to really reflect on the following questions, and answer the questions to the best of your ability.

22. What are the greatest lessons you have learnt so far in your life? *

23. Where do you get your energy from? *

24. Where are you most irresponsible? *

25. Make a list of things you are putting up with in your life? *

26. Your legacy? What do you want to leave after your gone? Be specific. *

27. What do you want professionally? What do you offer that is unique and/or excites you? *

28. What parts of your work do you enjoy the most and the least? *

29. Who do you know (identify your networks)? *

30. What are 3 opportunities that you are currently not making the most/anything of? *

31. Why have you hired a coach? *

32. How will you know when you are getting value from coaching? *

Life Sectors

Define 8 life sectors and rate them according to your level of satisfaction now (1 low – 10 high). For Example : Relationships, Career, Social Life, etc

Sector 1 *

Number Slider 1

Selected Value: 0

Sector 2 *

Number Slider 2

Selected Value: 0

Sector 3 *

Number Slider 3

Selected Value: 0

Sector 4 *

Number Slider 4

Selected Value: 0

Sector 5 *

Number Slider 5

Selected Value: 0

Sector 6 *

Number Slider 6

Selected Value: 0

Sector 7 *

Number Slider 7

Selected Value: 0

Sector 8 *

Number Slider 8

Selected Value: 0

Outcomes

Identify the areas that you want held as your main focus for our sessions.

For each focus area, provide

Focus Area (F.A.) : Your Outcome
Ongoing evidence (OE) : A description of a measurable result – evidence that the goal is on it’s way to being achieved.
Final evidence (F.E.) : The evidence to show that the outcome has been reached.

These focus areas could be specific projects or tasks or ongoing quality of life shifts.

Examples:

Focus Area (F.A.) – Complete a project
Ongoing evidence (O.E.) – I have outlined tasks I must finish and I stay on a timetable that gets the work done within my time frame.
Final evidence (F.E.) – the project is complete.

Focus Area (F.A.) – I feel more in control, less in overwhelm at work.
Ongoing evidence (O.E.) – I have a system to follow up on the small steps that will lead to the completion of larger goals and I consistently take action on the steps. I am able to limit my obligations so that I have a manageable amount to do. I allow myself regular breaks from work so that I can re-charge.
Final Evidence (F.E.) – I feel more relaxed at work.

Focus Area 1

Ongoing Evidence 1

Final Evidence 1

Focus Area 2

Ongoing Evidence 2

Final Evidence 2

Focus Area 3

Ongoing Evidence 2

Final Evidence 3

Coaching Agreement

I am committed to creating a powerful coaching alliance with my coach that will support me in reaching my outcomes and living the life I want. My coach agrees to hold all content of our sessions completely confidential, which is considered to be privileged information. Work can also be carried out without revealing content if the client so wishes. *

Yes
No

Signed : *

Please print your name to agree to the terms and conditions of this coaching agreement.