Questionnaire Private Coaching

We combine scientifically validated diagnostics and internationally recognized methods in order to enable change and implement those changes holistically and sustainably.

To prepare for your first appointment, please complete this questionnaire as complete and accurate as possible. The information collected enables us to make an initial analysis of your living environment, concerns and goals. It will be kept confidential and exclusively serves to organize your coaching.

Our experience shows that a differentiated analysis of the current situation is the starting point for successful and sustainable changes. Therefore, we collect data that reflects various aspects of your personality and your professional and private situation.

Please take some time to answer and answer spontaneously. Unless otherwise stated, please refer to the last three months.

Please fill out the form before your first appointment with us.

Instructions on filling in the form

· Please answer the questions in keywords in the text boxes below.
· Mandatory fields are marked by *.

Questions about your person

Your name*:

Address:

Date of birth:

Gender*:

female

male

Nationality:

Martial status:

Children (age, gender/none)

Size in cm:

Weight in kg:

Job

Employment

Title/Position

Total time of employment:

Highest level of education:

Graduation year:

Coaching goals and motivation Please click on the items that apply to you.

Self-Development and Growth

Health, Mindfulness and Resilience

Work-Life Balance

Back to Business

other, please specify

Coaching topics

Please describe your primary concerns (or problems) in short sentences or keywords.

Since when do you have this concern or problem?

Why did you decide to seek support now?

Who else is affected or involved besides you and how does the problem affect others or their living environment?

If other people are involved or affected: How would they describe your problems or concerns?

What have you already tried to achieve a change? What worked and which attempts were unsuccessful?

How would you realize that a positive change is beginning?

Please write down specific questions that you have regarding your desire to change.

Additional personal information

How much do you enjoy working in your current job? (Scale from 1 no joy at all to 10 very much joy)

Are there any stressful factors in your workplace?

Yes

Does your work include business travel?

Yes

Have you made use of coaching before?

Yes

Have you been in psychotherapy?

Yes

When was your last medical check-up?

Were there any abnormalities?

Yes

Please rate the following items on a scale of 1 (very bad) to 10 (excellent):

Sleep

Nutrition

Movement

Health

Social Reationship

Family

Leisure

Professional

Financial Situation

Are you currently in a relationship?

Yes

Do you live alone or with another person(s)?

Alone

Partner/Spouse

Family

Roommate

Do you currently attend relatives in need of care?

Yes

Have you experienced any recent stress, grief, major changes or losses?

Yes

Are you pregnant?

Yes

Do you suffer from chronic pain?

Yes

Do you currently take painkillers / prescription drugs / performance enhancing substances /sleeping pills?

Yes

Do you drink more than 1 glass of alcohol per week?

Yes

Do you follow a specific diet?

Yes

Do you diet regularly?

Yes

Do you take dietary supplements?

Yes

Would you describe yourself as spiritual or religious?

Yes

What do you consider your personal strengths?

What do you consider your weaknesses?

Are there any moods, symptoms, or other specific issues that you consider important and have not yet been otherwise inquired?

Yes

Are you ready to open up to new perceptions of your personality and your personal environment in coaching?

Yes

Are you able to comply with agreements?

Yes

Are you physically, mentally and financially capable and willing to invest in personal development through individual coaching?

Yes

And finally: How do you spend your time?

How much time per day do you spend on the following activities on weekdays (WD) and weekends (WE)?
(please refer to a "standard week" of the last two months)

weekdays

weekends

Work

Exercise

Media consumption

Household / Family

Friends

Art / Culture

Eat out

Other

if other, please specify.

Submit

EXCELLENCE IN MIND – LIESENFELD EXECUTIVE COACHING GMBH

The Liesenfeld Executive Coaching GmbH with its guiding principle EXCELLENCE IN MIND is an international coaching and consulting company, established in 1999. It is our mission to guide people towards personal maturity and professional excellence. With our own research sector (www.liesenfeld-institute.com), we work on a profound neuroscientific and personality psychological basis. We support companies and their executives with a major focus on authentic leadership, generation change in family businesses and transformational change. Core values informing our approach and manner of working are a fundamental stance of appreciation, professional excellence, growth and freedom.

MEMBERSHIPS

OFFICE HAMBURG

Liesenfeld Executive Coaching GmbH
Theodorstr. 42-90, Haus 6a, Loft 631
D-22761 Hamburg

phone: +49 40 67387358
hamburg [at] excellence-in-mind [dot] com

OFFICE BOSTON

Liesenfeld Research Institute
96 Appleton Street
Boston, MA 02116 (USA)

phone: +1-617-8388448
boston [at] excellence-in-mind [dot] com

The Liesenfeld Executive Coaching GmbH (previously Corporate Coaching Company) with its guiding principle EXCELLENCE IN MIND is an international coaching and consulting company, established in 1999. It is our mission to guide people towards personal maturity and professional excellence. With our own research sector (www.liesenfeld-institute.com), we work on a profound neuroscientific and personality psychological basis. We support companies and their executives with a major focus on authentic leadership, generation change in family businesses and transformational change. Core values informing our approach and manner of working are a fundamental stance of appreciation, professional excellence, growth and freedom.

Office Hamburg
Liesenfeld Executive Coaching GmbH
Theodorstr. 42-90, Haus 6a, Loft 631
D-22761 Hamburg, Germany

Tel.: +49 40 67387358
info@excellence-in-mind.com

Office Boston
Liesenfeld Research Institute
96 Appleton Street
Boston, MA 02116 (USA)

phone: +1-617-8388448
info [at] excellence-in-mind [dot] com