Retirement Coaching Intake Form

Professional History

Education

What are the primary reasons you are entering into a coaching experience at this time?

Where are you Now?
How would you rank your current level of satisfaction with each of the following areas of your life?

Life Area
Very Satisfied
Satisfied
Dissatisfied
Work
Emotional Health
Physical Health/Well-being
Mental Health
Finances
Spirituality/Religion
Relationship With Spouse/Significant Other
Relationship With Children
Social Network/Friendships

What are your most important goals for the next 6-12 months?

1)
2)
3)

What are the primary issues you would like to focus on during our coaching – or outcomes you would like to experience?

1)
2)
3)

What else would you like to share about your current life situation?