Coaching Questionnaire Form

Please complete the following as thoroughly as possible.

First name

Last name

Phone

Address

Occupation

Coaching Objectives

What motivated you to seek coaching?

What specific goals would you like to achieve through coaching?

What challenges are you currently facing?

Have you worked with a coach before? If yes, please elaborate.

Personal Insights

How do you handle stress or challenges?

What are your strengths and weaknesses?

What activities or practices help you feel balanced and fulfilled?

Are there any important life experiences that have shaped who you are today?

Health and Well-being

Do you have any physical or mental health concerns that I should be aware of? If so, please elaborate.

Current medications? (Yes/No) If yes, please list them.

How would you rate your overall well-being on a scale of 1-10? (1 being low, 10 being high)

What are your preferred methods of self-care?

Coaching Logistics

Preferred method of communication?

In-person

Phone

Video call

What days/times work best for you for coaching sessions?

Do you have any preferences or requests regarding the coaching process?

Liability Waiver

Client Liability Waiver

I, ___________________ (client's name), understand that I am voluntarily participating in life coaching sessions with Rick Osborn. I acknowledge that coaching does not involve the diagnosis or treatment of mental disorders, and it is not a substitute for professional advice from a licensed mental health or medical professional.

I understand that coaching is a partnership that requires my active participation, and I am responsible for my own decisions and actions.

I hereby waive and release Rick Osborn from any and all claims, liabilities, or damages that may arise from my participation in coaching sessions, including but not limited to any personal injury or damages incurred during the sessions.

I understand that all information provided is confidential and will not be shared without my consent, except as required by law.

By signing below, I affirm that I have read and understand this liability waiver, and I voluntarily agree to its terms.

Client Signature: ______________________________(type name for Signature)

Date: _______________