Welcome!

Thank you for taking the time to complete this form. Your answers will help me understand your current situation, goals, and how I can best support you during your coaching journey.

Section 1: Personal Information

First name

Last name

Email

Phone

Preferred Method of Communication

Email

Phone

Text

Other

Section 2: Current Situation

What area of your life are you most focused on improving or changing?

Career

Life transition

Personal growth

Other

Briefly describe your current situation and any challenges you’re facing

Section 3: Goals & Motivation

What would you like to achieve through coaching?

Why is achieving this important to you right now?

On a scale of 1–10, how committed are you to making changes in this area?

Section 4: Strengths & Resources

What personal strengths or skills do you feel will help you succeed?

What support or resources do you currently have?

Section 5: Barriers & Concerns

What obstacles or challenges do you anticipate?

Have you worked with a coach or mentor before? If yes, what was helpful or not helpful?

Section 6: Preferences & Expectations

How do you prefer to work with a coach?

Structured exercises

Discussion-focused

Accountability-focused

Other

Anything else you want me to know to best support you?

Consent: “I understand that coaching is a collaborative process and that progress depends on my active participation. I consent to coaching sessions with Jan Hickey.”

Embrace your passion and strengths

Welcome!

Thank you for taking the time to complete this form. Your answers will help me understand your current situation, goals, and how I can best support you during your coaching journey.