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AZER Coaching Enterprises
Client Information:
Date: _______________________
Name: _______________________________________________________________________
Address: _____________________________________________________________________
City/Sate/Zip: _________________________________________________________________
Marital Status: _________________ Email: __________________________________________
Phone Home: _________________________ Cell: ____________________________________
Is it OK to leave a message at home? _______ on Cell? _______
Birth Date: ______________________ Age: _________
Where did you hear about our services? ______________________________________________
Have you experienced coaching before: ______________________________________________
_____________________________________________________________________________
Are there any medical conditions I need to be aware of? _________________________________
_____________________________________________________________________________
Take time to thoughtfully consider your answers to the following questions. Use as much space as
needed. Write freely and without self-consciousness. The purpose of this exercise is to help you
broaden your thinking and help your coach learn about you.
Please complete and email to your coach at least 48 hours before your first session.
Reza@AzerCoaching.com
1. Why are you seeking coaching at this time?
2. What are your strongest beliefs about yourself and your view of the world right now? Please
state both positive and negative beliefs.
3. What gifts do you have that you could make available to the world?
4. When in your life have you felt most creative?
5. What are the greatest accomplishments of your life?
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6. What bit of wisdom would you share with the world now?
7. What energizes you?
8. What do you want to accomplish in the next six weeks? OR What area of your life do you
want to focus on?
9. What is the benefit for you in accomplishing your goal?
10. How do you want your ACE coach to help you?
11. How might you sabotage this coaching process?
12. What is one powerful question you could ask yourself about your goal?
13. How will you know how effectively coaching has been for you?
14. Write one sentence each, I’d like to change my life in these 3 ways:
a.____________ b.____________ c.____________
15. I want to improve my skills in the following areas:
a.____________ b.____________ c.____________
16. If I had a magic wand, I would wish that ______________________
(a Person) would do one of these 3 things:
Treat me differently Understand me better Disappear into thin air
17. If it was impossible for me to fail I would like to:
a._____________ b.____________ c.____________
18. If I had all the time in the world, I would be doing:
a._____________ b._____________ c.____________
HOW HAPPY DO YOU FEEL RIGHT NOW IN RELATION TO THE FOLLOWING?
(10 Extremely Happy, 1 Very Unhappy)
Family: Work: Health:
Finances: Career: Friends/Social Life:
