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Emotional Resiliency Leadership Coaching Intake Form

Welcome!

Before we begin, please take a few moments to fill in this form. Your responses will help us assess if we’re the right fit and ensure the coaching experience is tailored to meet your unique leadership needs.

 

Click the button below to start.

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Personal and Professional Information

Please share more about your industry and the specific challenges you’re facing within your company. This information allows us to tailor our approach, ensuring that our coaching sessions are precisely aligned with your needs and objectives. Understanding your context helps us determine how best we can support your leadership journey.

 

Question 2 of 21

Full Name:

Question 3 of 21

Email Address:

Question 4 of 21

Phone Number:

Question 5 of 21

Job Title:

Question 6 of 21

Company Name:

Question 7 of 21

Industry:

Leadership Challenges

We invite you to share any details you're comfortable with regarding your current leadership challenges. This insight helps us gain a clearer understanding of your needs, allowing us to better assess how we can effectively support you on your leadership journey.

Question 9 of 21

What is your primary leadership challenge right now?

(Select all that apply)
A

Managing high-pressure situations

B

Navigating organizational change

C

Team dynamics and motivation

D

Decision-making under uncertainty

E

Balancing strategic vision with day-to-day operations

F

Other (please specify)

Question 10 of 21

Other, please specify here:

Question 11 of 21

How would you rate your current level of emotional resilience in your leadership role?

 

(Scale of 1 to 10, with 10 being extremely resilient)

Question 12 of 21

What strategies have you tried in the past to manage stress and maintain resilience?

Question 13 of 21

How do you currently approach decision-making in high-stress or uncertain situations?

Organizational Context

Please share any organizational context you feel comfortable with, such as your company's goals, culture, and current challenges. This information helps us tailor our approach to align with your organization's unique dynamics, ensuring our support is both relevant and impactful.

Question 15 of 21

Describe your organization’s current environment:

(Select all that apply)

(Select all that apply)
A

High growth and expansion

B

Digital transformation

C

Restructuring or downsizing

D

Stability and steady growth

E

High turnover

F

Cybersecurity challenges

G

Other (please specify)

Question 16 of 21

Other (please specify):

Coaching Goals

We encourage you to share your coaching goals and aspirations. This insight allows us to align our sessions with your objectives, ensuring that our work together is focused, meaningful, and tailored to help you achieve the outcomes you desire.

Question 18 of 21

What do you hope to achieve through this coaching session?

(Select all that apply)

(Select all that apply)
A

Immediate stress relief and clarity

B

Long-term resilience building

C

Enhanced decision-making skills

D

Improved team leadership

E

Greater work-life balance

F

Strategic insights for navigating digital challenges

G

Other (please specify)

Question 19 of 21

Other (please specify):

Question 20 of 21

What would a successful coaching session look like for you?

Question 21 of 21

Is there anything else you’d like to share that could help us contribute to a successful outcome? Any additional insights or details will ensure that our collaboration is fully aligned with your needs and expectations.

Confirm and Submit