Client Discovery Form - You Are Made New

Welcome to Coaching!

The form below constitutes some preliminary information that will help your coach understand you and your needs. All personal information is confidential and is treated appropriately.

NOTE: there is a ‘Save and Continue Later’ option at the very bottom of the form. You do not have to complete the entire form in one sitting.

Personal Information

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Mobile Phone

Birthdate

Key people in your life:

List the area(s) that you want held as your main focus during our coaching relationship.

For Example:

Better self-support, healthier self-image, eliminate negative self-talk.
Grow closer to God, open more to Him and His love.
Heal from the effects of traumas or childhood wounding.
Reduce anxiety, trust in God's sovereignty.

Is there a place in your life where you feel “stuck” and unable to act/think/feel as you really want to? This could be a thought pattern, an addiction, an emotional reaction, a pattern of events that seems to recur.

What would you say have been your 3 greatest accomplishments to date?

What are the significant traumas in your life (i.e., loss, hurt, humiliation, fear, etc.)?

What, if any, major transitions have you experienced in the past two years?

Briefly describe your relationship with God.

Have you worked with a coach or been in therapy before? If so, what worked well for you and what did not?

Rate the amount of stress in your life right now (1=low, 10=high)

What are your primary stressors?

List 3-5 adjectives that describe you at your best:

List 3-5 adjectives that describe you at less than your best:

Balance Assessment

Rank your level of satisfaction with the following areas of your life (0 to 100%). To do this think about where you are now versus where you want to be (ultimate=100%).

Physical Health %

Family %

Finances %

Career %

Spiritual %

Emotional %

Friendships %

Fun and Recreation %

Is there anything else that you want to be known about you or your situation that you think is important to share?

I understand and agree to the below terms (please check each box to indicate your agreement):

An invoice for each month's coaching will be emailed to you at the end of that month. You may choose to pay for each session as you go, or wait for the invoice to pay for the month.

Invoices can be paid by check, credit card, venmo or paypal.

If a scheduled coaching session needs to be canceled, please do so at least 24-hours in advance of that session.

If you are late for a session, that session may need to end at the scheduled time, depending on the coach's schedule.

The coaches of You Are Made New Ministry meet regularly to support one another and continue learning and growing together. As such, client scenarios may be presented during these meetings for the purpose of receiving input and counsel.

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Phone

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