Welcome

I am very happy that you approached me as a coach and look forward to working with you to shape this coaching process the way you really want it.

I invite you to take some quiet time (15-30minutes) to review and complete this personal questionnaire. Please provide spontaneous and sincere answers in any form. Completing your personal information will help me better support you and ensure that I am meeting ethical requirements.

Please complete this questionnaire prior to our first coaching session.

Please note that you cannot return at a later time and that the form must be completed and sent in 1x.

Intake form coaching process

Personal information

Your information will be treated with strict confidentiality.

First name

Prefix

Last name

Your phone number

Phone number of organization or loved ones

Private email address

Home address

Place of residence

Date of birth

How many hours a week do you work?

Employer

Profession

Function

I hereby confirm that I have received the terms and conditions of delivery in the welcome letter, have read them and agree to them.

I want to be notified of coaching tips and behind-the-scenes information and recommendations for interesting books on executive coaching and leadership. Marijne promises to send you interesting and practical content.

Questions

The following questions will help me get to know you better. Please take the time to complete these questions.
Please note that you cannot return at a later time and that the form must be completed and sent in 1x.

What is the reason for starting a coaching program now?

What are the key outcomes you hope to manifest as a result of a successful coaching relationship?

How do you know the coaching has been successful?

What 3 things about yourself, your private situation or environmental factors that currently surround you could jeopardize the success of this coaching relationship?

What do you expect from your coach? Especially if the coaching process is more difficult?

When do you feel most alive? Or what activities have heart and meaning for you?

Do you have religious or spiritual beliefs, and if so, how do they affect your life?

What is your greatest ambition for our coaching? What would be the best outcome you could hope for?

What is your lowest ambition? What are some of your fears about this coaching that you are aware of at this stage?

Could you tell us something about yourself, your background, family composition, major life-shaping events, which have influenced who you have become, so that we can make it the most successful coaching relationship from the beginning?

Thank you for your thoughtful responses. I very much look forward to receiving them and discussing them together.

Your coach,
Marijne van den Kieboom