Empowerment Coaching Questionnaire

Thank you for embarking on a journey of change, discovery, and the path to beYou. Please take some time to read through this questionnaire and answer all the questions with honesty and openness. If you don't know how to answer a questions, feel free to leave it blank. Make sure to take your time and not rush. Return it to me 48 hours prior to your first appointment (if your appointment is scheduled less than 48 hours prior to your appointment, please fill this out immediately and get it back to me).

My approach to coaching is holistic in order to address the interconnectedness of all things and in order to generate change, we need to become aware of all areas of life rather than focusing on singular matters. Whether you are in a life transition, struggling with a difficult decision, have specific goals you want to achieve, would like to improve your relationships, etc., there is usually more to unpack than what is right in front of you. The outcome is empowering as you will reconnect to your purpose and find fulfillment in all areas of your life.

This work is not always easy. I ask you to make this commitment to yourself, to keep an open mind, and to be courageous. What lies ahead is great change within yourself. If at any point something is not working for you, please be honest and kindly share with me what is going on.

As your coach, I will be your partner as you work towards your goals, here to support and challenge you. I will hold you accountable for actions you choose to take to work towards your goals. Everything you share is confidential, unless you share with me you are being harmed, plan to harm someone else, or plan to harm yourself. I am required by law to break confidentiality to make sure these things do not happen.

In our first session together we will design an alliance in how we want to work together. During this time I will share with you some coaching nuances that might take place in our sessions. Please come curious and open.

I look forward to supporting your journey to beYou.

First Name

Last Name

Email Address

Mailing Address

Phone number

Birthday

What are your pronouns?

List other important people/pets in your life and their relationship to you (personal or professional).

Reflection Questions

In preparation for coaching, please take some time to reflect and answer these questions before we meet. When it comes to your goals, think BIG and don't worry about how you will get there. When it comes to challenges be honest with yourself.

What do you want to accomplish through coaching? What goals and dreams are you aiming for? What are you trying to change or grow?

What are you most proud of in your life? What are the beliefs, strengths or behaviors that enabled these accomplishments?

What beliefs or behaviors get in your way of achieving what you want?

What challenges do you have in your life? What’s missing? What holds you back?

What motivates or encourages you?

What would you do if you knew you couldn’t fail?

Is there anything else that came up while reflecting on the above questions you would like to share?

Forming a Coaching Partnership

As your coach, I want you to succeed in achieving the results you want. To best support you in a way that will help you grow and navigate difficulties, please take some time to answer on the following questions with honesty.

What's your previous experiene with coaching and therapy? What worked? What didn't work?

What do you need from me as your coach?

What's the best way to hold you accountable for the commitments you make during our coaching sessions? When you commit to an action, what kind of accountability will serve you?

How do you want me to give you feedback while coaching together? How will you let me know what is and isn't working?

How will you know when our work together is complete?

What else do I need to know about you that will help me be an effective coach for you?

By checking this box I agree to the terms and conditions described in the Empowerment Coaching Agreement

Thank you for taking the time to fill out this questionnaire. The information you provide is confidential and will be read with attention by me. I look forward to embarking on this empowerment journey with you.