Integral Coaching: Client Questionnaire

Please answer a few questions to help me get a better sense of your needs and interests. The information you enter here will be kept strictly confidential.

Note: once you submit this form, you will not be able to edit it, so you may want to compose some of your answers in a text editor (e.g., Microsoft Word) and then paste them in.

Name and Contact Information

Name and Age: *

Address: *

Email: *

Cell Phone:

Work Phone:

Home Phone:

Website (if any):

Personal Information

Are you married, single, or divorced? If married, what is your spouse's name and age?: *

Do you have children? If so, what are their names and ages?: *

What do you do for a living, and where do you currently work? How long have you been in your position?: *

What is your highest level of education? What degree(s) do you hold? Any other training?: *

Purpose & Motivation

What is your immediate purpose and motivation for investigating Integral Coaching?: *

What is your "Big Picture" purpose and motivation for considering Integral Coaching?: *

Past Experience

Please describe your past experience with focused personal growth: *

Please describe your past experience with spiritual and meditative teachings: *

Please describe your past experience with therapy: *

Please describe your past experience with coaching or Integral Coaching: *

Personality & Interests

What would you like to share about your personality type (Enneagram type, Myers-Briggs type, or other relevant typology)?: *

What are the primary opportunities that excite you now?: *

What are the primary challenges you are working with in your life now that you would like to address in coaching?: *

What draws you to consider arranging for coaching with Terry Patten?: *

Desired Outcomes: *

What outcomes would you hope for from this coaching?

Time Commitment & Availability

Length of Coaching: *

1-3 months

4-5 months

6-8 months

9 months or more

If you have a successful experience, how long a course of coaching are you imagining?

Please indicate the times and days of the week when you might have hours available for coaching sessions: *

Last Question

Anything else you want to tell us or ask about?:

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Integral Coaching: Client Questionnaire

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