Pre-Coaching Questionnaire

Section 1: Personal & Contact Information

Full Name

Preferred Name (if different)

Email Address

Phone / WhatsApp Number

Date of Birth (YYYY-MM-DD)

Location / Time Zone

Occupation / Current Role

How did you hear about me?

What initially drew you to explore coaching with me rather than with someone else?

Section 2: CURRENT LIFE SNAPSHOT

On a scale of 1-10, where 1 is “very dissatisfied” and 10 is “thriving”, how would you currently rate the following areas of your life?

Which 2-3 areas currently feel most challenging or “stuck”, and why?

How long have your main challenges been present?

How would you describe your support system at the moment (family, friends, colleagues, mentors, community)?

Section 3: YOUR STORY & INNER WORLD

What are 1-2 key life events or turning points that have shaped who you are today?

What repeating patterns do you notice in your life that you would like to understand or change (for example, people-pleasing, procrastination, conflict avoidance, self-criticism, overworking, relationship patterns)?

What are your top 3 values at this stage of your life?

Section 4: Goals & Aspirations

List up to 3 specific changes or outcomes you would love to see over the next 6-12 months.

Why are these changes important to you?

Write one clear sentence describing the person you want to become by the end of this coaching journey.

Section 6: WELL-BEING & SUPPORT

Are you currently receiving support from any other professional, such as a therapist, counsellor, psychiatrist, or medical practitioner?(required)

Yes No

Have you experienced significant anxiety, depression, trauma, or thoughts of self-harm in the past 12 months? (You may share as much or as little detail as feels appropriate here. This helps me ensure you have the right kind of support.)

Is there anything related to your mental, emotional, or physical health that you feel I should be aware of before we begin?

SECTION 7. PRACTICAL DETAILS

Preferred coaching start date (YYYY-MM-DD)

Preferred session format(required)

In-person (where available) Online (Google Meet) A mix of both

Preferred frequency and timing of sessions (E.g. Once a week in the evenings, for 3 months)

Which coaching track suits your needs, goals and expectations?(required)

FOUNDATION Plan (1 session) GROWTH Plan (4 sessions) ACTION Plan (4 sessions) MASTERY Plan (4 sessions)

Compatibility Between Coach and Coachee is Crucial!

Your pre-coaching questionnaire has been submitted.