The Long Game — Executive Coaching Intake Survey

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Question 1

How would you describe where you are in your life and career right now?

A sentence or two is fine — speak freely.

Question 2

What is the single most important thing you want to accomplish in the next 12 months?

Personal, professional, or both — this is your space.

Question 3

Which areas of your life are you most hoping coaching will support?

Select all that apply.

Leadership & career direction Health & physical wellbeing Financial goals & wealth building Mental health & stress Relationships & community Purpose & legacy Work-life integration Personal reinvention

Question 4

What does success look like to you at this stage of your life — and has that definition changed?

Be as honest as you like.

Question 5

What is the biggest obstacle standing between you and the life you want?

This could be internal, external, or both.

Question 6

How would you describe your relationship with your own health and wellbeing right now?

Thriving — I feel strong and well-resourced Managing — I get by but it could be better Depleted — I've been running on empty In transition — something is shifting for me

Question 7

What strengths do you most want to lean into during this coaching engagement?

What do you know you bring — and want to use more intentionally?

Question 8

Is there something you've been avoiding or putting off that you know needs your attention?

This is a judgment-free space.

Question 9

How do you tend to show up when things get hard — and is that working for you?

Question 10

On a scale of 1–10, how clear do you feel about your sense of purpose and direction right now?

1 = very unclear · 10 = crystal clear

Very unclearCrystal clear

Question 11

What do you most need from your coach in this relationship?

Select the approach that resonates most.

A thinking partner — someone to help me work through complexity An accountability partner — someone to keep me honest and moving A challenger — someone who will push me beyond my comfort zone A mirror — someone to help me see myself more clearly A blend of all of the above

Question 12

Is there anything else you want your coach to know before your first session?

Context, concerns, hopes — anything that feels important to share.

Question 13

What limitations or constraints might get in the way of achieving your goals?

Think about time, resources, relationships, mindset, health, or anything else that feels like a real barrier.

Time and competing demands Financial resources Self-doubt or fear Health or energy Unsupportive relationships or environment Lack of clarity or direction Systemic or structural barriers Other

Question 14

Describe what living a big, full life looks like for you.

No limits, no qualifiers — just your truest vision. What does it feel like? What does it include?

Question 15

Would you be interested in participating in an out-of-state weekend women's retreat focused on supporting your big life strategy?

Our retreats are small, curated gatherings designed around Rest, Reflect, and Recover — a dedicated space for women to invest in themselves.

Yes — absolutely, tell me more Yes — interested but need more details Maybe — depends on timing and cost Not right now, but keep me informed No — not something I'm looking for

"The Long Game begins with a commitment to yourself."

✦

Thank you, and welcome.

Your responses have been received. Your coach will review them before your first session and reach out shortly to confirm your schedule.

We are glad you're here — and we're ready to get to work alongside you.

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