Client Questionnaire for Coaches or Psychologists
Gather essential insights to tailor your first coaching/psychology session effectively and align on your goals and expectations.
- Steps
- 13
- Last edited
- Aug 28, 2026
- Created by
- Nova
About this process
A questionnaire to learn about the client or patient, their belief system, expectations, and goals.
The process in detail
13 steps- 1
Please confirm your name and email address.
- 2
What is the primary challenge or pattern you wish to address in our sessions?
- 3
Imagine your life or mindset remains unchanged over the next six months: What specific personal, emotional, or practical costs might arise for you?
- 4
Envision Success: If our work together is incredibly successful, what tangible changes would you see in your daily life, behaviors, or internal state?
- 5
Clarify Expectations
- 6
What do you believe has prevented you from achieving this desired outcome on your own until now?
- 7
Is there a story or a deeply held belief about yourself that you feel might be contributing to you feeling stuck?
- 8
Define Core Values: What are three core values that deeply guide your decisions and actions?
- 9
How do you best receive feedback or challenge?
- 10
How often do you currently engage in physical exercise or intentional movement?
- 11
How consistently do you practice self-reflection, journaling, or checking in with your internal state?
- 12
What is one thing I should know about you that doesn't typically show up on a standard intake form?
- 13
Final Thoughts & Questions
Read the full text
1. Please confirm your name and email address.
2. What is the primary challenge or pattern you wish to address in our sessions?
Briefly explain why resolving this is a priority for you right now, and what makes this the right time to work on it. This helps me understand your immediate focus and motivation.
Please write your response.
3. Imagine your life or mindset remains unchanged over the next six months: What specific personal, emotional, or practical costs might arise for you?
Understanding this helps us identify your internal stakes and leverage for change. Please share your thoughts.
4. Envision Success: If our work together is incredibly successful, what tangible changes would you see in your daily life, behaviors, or internal state?
Be specific about what success looks and feels like for you. Your detailed vision helps us set clear targets.
Please describe your vision.
5. Clarify Expectations
To ensure alignment, please share your expectations for me as your coach/psychologist, and equally important, what you expect from yourself throughout this process.
6. What do you believe has prevented you from achieving this desired outcome on your own until now?
Consider both external circumstances and internal factors. Identifying these helps us pinpoint potential systemic blockers.
Please describe what has held you back.
7. Is there a story or a deeply held belief about yourself that you feel might be contributing to you feeling stuck?
8. Define Core Values: What are three core values that deeply guide your decisions and actions?
Consider principles like honesty, growth, compassion, freedom, or connection. Where do you feel you might be out of alignment with these values in your life right now?
Identify your values and alignment.
9. How do you best receive feedback or challenge?
Do you thrive with direct, unfiltered honesty, or do you prefer a gentler, more exploratory approach? This helps me tailor my communication to your needs.
Select your preferred feedback style.
- 🗣️ Direct Honesty: I prefer straightforward, unfiltered feedback.
- 🧭 Gentle Exploration: I prefer a softer, more guiding approach.
- 🤝 Collaborative Discussion: I like to discuss feedback together.
10. How often do you currently engage in physical exercise or intentional movement?
Select the option that best describes your routine.
- 🛋️ Never: Physical movement is currently absent from my routine.
- 🚶 Rarely (1x/week or less): I occasionally go for walks or light activity, but it's unstructured.
- 🏃 Sometimes (2–3x/week): I have a basic routine, though it frequently gets interrupted.
- 🏋️ Consistently (4–5x/week): Exercise is an established, dependable weekly habit.
- ⚡ Daily exercise (6–7x/week): Intentional movement is a non-negotiable part of my daily life.
11. How consistently do you practice self-reflection, journaling, or checking in with your internal state?
- 😶🌫️ Never: I avoid looking inward and rarely pay attention to my internal thoughts or feelings.
- 🌪️ Only in Crisis: I only reflect, journal, or examine my thoughts when I hit an emotional wall.
- 📝 Occasionally: I practice self-reflection or journaling a few times a month when I need clarity.
- 🧘 Consistently: I regularly check in with myself, journal, or practice mindfulness multiple times a week.
- ✨ Daily Practice: Daily self-reflection, writing, or internal check-ins are an essential, non-negotiable anchor in my life.
12. What is one thing I should know about you that doesn't typically show up on a standard intake form?
13. Final Thoughts & Questions
Feel free to express anything else that comes to mind.