Client Information Form

Understanding Your Story

Understanding Your Story

Stephen Simms

Business & Executive Coach

This client information form will help me learn a little more about you and your needs. Please fill out what information you feel comfortable sharing.

Please note this information will never be shared with a third party, it will only be used for coaching purposes.

I'd love to learn a little bit more about you or your business

Your Name*
Your Email Address*
Your Phone Number
How Can I Help?*
- I Am A Business Owner
- I Am An Executive
Understanding Your Business
If you are willing, it would be helpful for you to share a little on where you are today in your business and where you would like to be in the future. Please take a few minutes and provide answers to the following questions which will create efficiency and awareness for when we speak live.
First tell me a little about your business
Describe your business: (who you service, what you sell, etcetera…)
How many years have you been in business?
Number of Employees:
Annual revenue range of your business:
Are you a single owner or partnership?
What do you like most about your business?
What do you like least about your business?
Describe your greatest achievement in your business since starting it:
Where are the Gaps?
Where are you today in your business that is not quite where you want it?
What are you looking to change, advance, grow or alter in your business?
Describe how well your goals and strategic direction is defined for you and your team?
What is essentially missing from your business that you know you need to either acquire, find, develop, replace, etcetera?
What do you FEEL you NEED right now in your business?
How do you see coaching helping you close the gap versus continuing to tackle it yourself?
Understanding Your Career
If you are willing, it would be helpful for you to share a little on where you are today in your career and where you would like to be in the future. Please take a few minutes and provide answers to the following questions which will create efficiency and awareness for when we speak live.
First tell me a little about your career and place of employment
Describe your Company: (company name, what they do, etcetera…)
How long have you worked for the company?
What is your current position and how long have you held it?
Number of Direct Reports that you currently lead:
What position do you report to in the company?
Do you have responsibility for a profit/loss center and if yes, what is the annual dollar value?
What is your highest level of education, training or leadership development?
Describe your greatest achievement in your career thus far:
Where are the Gaps?
Where are you today in your career that you sense is not quite where you would like it to be?
What are you looking to change, advance, grow or alter in your leadership and/or career?
Describe how well your career and life goals are developed and lived by you:
How well are your division and/or corporate goals and corporate strategic direction understood by you and your team?
What is essentially missing from your leadership approach that you know you need to either develop, grow, change, improve, etcetera?
What personal competencies are you confident in as it relates to the execution of your role?
What do you FEEL you NEED to do right now in your career to ensure continued success?
How do you see coaching helping you close the gap versus continuing to tackle it yourself?

Understanding Your Story

Understanding Your Story

Understanding Your Business

First tell me a little about your business

Where are the Gaps?

Understanding Your Career

First tell me a little about your career and place of employment

Where are the Gaps?