1. Please let me know your name: *

2. Email *

3. What experience do you have of coaching? *

Haven't had any coaching, and I'm not sure it's for me

Haven't had any coaching, but I'm intrigued

Haven't had any coaching before, but I'm excited to have some

Have had some coaching previously

Have had lots of coaching

Am currently having coaching, but happy to be coached by you too

Other

If other, please explain

4. What positive change would you like to make about how you work or perform? *

5. What difference would it make to you if you were able to make these positive changes? *

6. What difference would it make to your team/the business if you were able to make these positive changes? *

7. If you have something specific you'd like to bring to coaching, please let me know here. If you're not sure, take another look at the suggestions in Section 2 of this form and come back to this question. *

8. What are your strengths and challenges as a communicator? *

9. Are you happy with your current work/life balance? On a scale of 1 - 10, where 1 is "Extremely unhappy" and 10 is "Extremely happy" *

10. How satisfied are you with your awareness of others (how much/often you take notice of other people's needs, feelings, behaviours) and how you interact with others? On a scale of 1 - 10, where 1 is "Extremely unsatisfied" and 10 is "Extremely satisfied" *

11. Are you keen to develop and improve in your role? *

Yes

Maybe

12. Are you open to receiving feedback? *

Yes

Maybe

13. Do you understand and agree that coaching is not therapy, advice, or counselling and that you may withdraw from the process or ask that a different approach be taken if you wish? *

Yes

14. Are you happy to be challenged (respectfully of course) by your coach? For instance, if you contradict yourself or if your statements don't stand scrutiny against the facts presented? *

Yes

Maybe

15. Do you agree to respect the coaching process, to attend meetings as agreed, to be open to change and to take responsibility for agreed actions? You must give at least 48 hours notice if you need to reschedule a session. *

Yes

16. Do you understand that you are responsible for your own physical, mental and emotional well-being, decisions, choices, actions and results arising out of coaching? *

Yes

Maybe

17. If you are currently under the care of a mental health professional, it is recommended that you inform them of the coaching programme prior to having the first pre-coaching session. *

I understand

Not applicable

Other

18. As a qualified coach, I am bound by the International Coaching Federation (ICF) Code of Ethics regarding my conduct, in particular the principles of confidentiality. However, our relationship is not considered a legally confidential one, so our conversations are not subject to the protection of any legally recognised privilege (as for the medical and legal professions). The ICF occasionally requests to see the name and email addresses of those coached as part of their verification process regarding ICF credentials. It would help me greatly if you would agree to appear on the list, but you may choose to have your name removed and your sessions will not count towards my official coaching hours. Appearing on the list merely verifies that you're a real person. No details of the coaching conversation will be shared. Please indicate below if you're happy for your name and email address to appear on the confidential list. *

Opt In (to sharing contact details with ICF should they request it)

Opt Out (of sharing contact details with ICF)

19. Your personal data will be stored confidentially for up to 6 years. You may ask to be removed from my database now (or at any time by emailing me at katehill@waterfallhill.co.uk). *

20. Please let me know any questions or concerns you have now here, and if you have any questions or concerns (about confidentiality or anything else) in the future, please let me know straight away. *

If you don't already have a session booked, please use the Calendly link sent with this information to book.

I look forward to making a start!