Personal Information Fact SheetAll information is confidential and is treated appropriately.

CLIENT INFORMATION

Today’s Date:

Full Name:

Mailing Address:

Birthday:

CONTACT INFORMATION:

Home Telephone:

Cell Phone:

Email:

What is the BEST way to reach you?

PERSONAL INFORAMTION:

Occupation:

Emergency Contacts:

1)

2)

Are you currently in therapy? Y / N Please elaborate if necessary:

Have you ever worked with a Coach? Y / N Please elaborate if necessary:

Primary FocusIdentify three or more main areas that you want held as your main focus during the coaching relationship. For each focus area, provide a simple heading and a description of a measurable result.

For Example:

Live my life so that at the end of it I have no regrets. That means I am clear about my values and what is most important and then make goals and take actions that reflect that.

1.

2.

3.

4.

The Coaching Relationship: Getting Started1) What do I really need to know about you (and how you make changes) that will

help me most in coaching you?

2) What is your biggest doubt about coaching and how it might (or might not) help you?

3) What do you want from me as your Coach and from our coaching relationship? FYI- This question is asking how you would like me to “be” as your Coach, not what goals you would like to accomplish.

4) What should I do or say to you when you are most “stuck” that will return you to action?

5) What will be the first small thing that might happen to indicate the coaching process is moving in the right direction?

6) What two steps could you take immediately that would make the greatest difference in you current life situation?

Coaching GlossaryBottom-Lining: This is the skill of brevity and succinctness on the part of both the coach and the client. Bottom-lining is also about having the client get to the essence of his or her communication rather than engaging in long descriptive stories.

Brainstorming: In this skill the coach and client together generate ideas, alternatives, and possible solutions. Some of the proposed ideas may be outrageous and impractical. This is merely a creative exercise to expand the possibilities available to the client. There is no attachment on the part of either coach or client to any of the ideas suggested.

Clearing: When the client is preoccupied with a situation or a mental state that interferes with his or her ability to be present or take action, the coach assists the client by being an active listener while he or she vents or complains. This active listening allows the client to temporarily clear the situation out of the way and refocus on the coaching session. Usually a two-minute time frame is given for this venting period.

Challenging: Challenging involves requesting that a client stretch way beyond his or her self-imposed limits. Challenges are outrageous requests! Frequently, in the face of a challenge, clients will be blown away by the “hugeness” of the challenge. It will open them up to a grander possibility for their life. If they are unwilling to fully take on the challenge they frequently respond with a counteroffer that is greater than they initially would have allowed themselves to make.

Confidentiality: All information that a client shares with a coach is held as confidential. This means that all information that a client confides in the coach is not shared with anyone else without the clients express permission. Confidentiality, the hallmark of the coaching profession, creates safety and trust and is the basis of the powerful designed alliance between client and coach.

Designing the Alliance: Clients design the alliance that will be most beneficial to and supportive of forwarding their actions toward their

goals and vision. This is done through making requests of the coach, setting up the logistics of the coaching relationship, and discussing the best ways to facilitate client learning and action. When clients grant power to the alliance, it then becomes necessary for the client to take responsibility for their part of the alliance. This is the “container” in which the coaching takes place.

Failure: Failure is the lack of achievement of a goal or activity to which one committed oneself. Failure is often confused with being wrong, morally shameful and being bad. To fail merely means that you did not succeed at what you set out to do. It is an opportunity for reflection and correction that can then forward the action toward success.

Goals: A goal is an outcome that the client would like to achieve. Goals are most helpful when they are measurable, specific, are owned by the client, have a date by which they will be accomplished, made public (in order to achieve support and accountability) and constitute a reasonable stretch for the client.

Gremlin/Saboteur: The Gremlin is a concept developed by Richard Carson that embodies a group of thought processes and feelings that maintains the status quo in our lives. Often operating as a structure that would seem to protect us, it in fact keeps us from moving forward and getting what we truly want in life. Like our minds, the Gremlin will always be with us. It is neither good nor bad; it just is. The Gremlin loses its power over us when we can identify it for what it is, notice our options in the situation and then consciously choose what it is we do really want at that time.

Homework Inquiry: When a powerful question is given at the end of the session, it is intended to deepen the client’s learning and provoke further reflection. The intention is for the client to consider the inquiry between session and to see what occurs for them. The inquiry is usually based upon a particular situation that the client is currently addressing.

Intrude/Take Charge: On occasion, the coach may need to intrude, to interrupt or wake-up a client who is going on and on, or who is kidding

themselves. Sometimes the intrusion is a hard truth such as “You are kidding yourself.” Sometimes the intrusion is simply stating what is going on, such as “You are skirting the issue.” Intrusion is considered rude in American society. The Coaches Training Institute views intrusion as being direct with the client, allowing the client to honestly assess and immediately deal with situations.

Intuiting: Intuiting is the process of accessing and trusting one’s inner knowing. Intuition is direct knowing, unencumbered by our thinking mind. The process of intuiting is non-linear and non-rational.

Life Balance: Life Balance is a dynamic and is always in motion. The client is either moving toward balance in their life or away from balance. The job of the coach is to facilitate moving toward Life Balance as much as possible. The areas to be balanced in life generally include Career, Money, Relationships with Family and Friends, Romance, Personal Growth, Fun and Recreation, Health and Physical Surroundings. If one of more areas are receiving attention at the expense of the others, life will feel unbalanced and bumpy.

Life Purpose: Life Purpose is about why you are here on the planet. Who is it that you are moved to be and what is it that you are moved to create? It is an essence statement that serves as a reminder of who you are and the impact that you naturally create in the world. When you are living your purpose, life is experienced as fulfilling, effortless and satisfying. When you are disregarding your life purpose, life is often felt to be empty, anguished and unfulfilling.

Requesting: One of the most potent coaching skills is that of making a request of the client. The request, based upon the client’s agenda, is designed to forward the client’s action. The request includes a specified action, conditions of satisfaction and a date or time by which it will be done. There are four possible responses to a request, 1) yes, 2) no, 3) a counter offer or, 4) agree to a future time that a response will be given.

Values: Values represent who you are right now. They are principles that you hold to be of worth in you life. People often confuse values with morals. Values are not chosen. They are intrinsic to you.

Credit Card Processing InformationI, , hereby authorize Penelope Rose Miller, to charge to the following credit card account in the amount shown below for monthly services. This payment agreement will be in effect until services have been completed or are ended by request of the client either verbally or in writing.

CREDIT CARD OR DEBIT CARD INFORMATION:Card Type: Visa MastercardCard Number:Expiration Date:CVV Number:

Name on Card:

Billing Address:Email Address:Amount: $Billing Cycle: 1st of every month for the sessions occurring in that monthCardholder's Signature: (typing your name is fine)