Questionnaire Submitted

Thank you for completing the Executive Coaching questionnaire. Your coach will review your responses before your first session and will be in touch shortly.

Initial Interview Form

Executive Coaching

CILC Advisory — Confidential Questionnaire

Please complete the following questions to help us jump-start the Executive Coaching process. All information is strictly confidential and used solely to guide your coaching sessions.

Contact information

Full name *

Company / organisation *

Email address *

Phone number *

Address

Date of interview

Coaching period / duration *

Tell me about yourself

Your age

Your family

Your work history

Important personal relationships

Interests and hobbies

Personal mission — and how your current role aligns (or doesn't)

Strengths & leadership

Your top 3–5 personal strengths (what you're naturally good at — at work or in life)

Your top 3–5 leadership strengths — and how they relate to your overall strengths

Areas you can most improve as a leader — and what difference it would make

Previous assessments

Have you completed any leadership assessments? (e.g. DiSC, Myers-Briggs, Gallup StrengthsFinder)

Yes No

Assessment 1

Assessment name

Results summary

What you learned about yourself

Assessment 2 (if applicable)

Assessment name

Results summary

What you learned about yourself

Greatest leadership challenge over the next 6–12 months — and how prepared you feel

Life balance wheel

Rate your current satisfaction in each life area from 0 (none) to 10 (complete). The wheel updates in real time as you adjust the sliders.

Career 5

Family & friends 5

Significant other 5

Fun & recreation 5

Health 5

Money 5

Physical environment 5

Personal growth 5

Previous coaching experience

Have you worked with an executive coach before? If so, describe the experience — positive or negative.

What from that experience would you like replicated in our relationship?

You can also print this form for your records.