New Coaching Registration Form

15 minute Complimentary Coaching Client Intake Form

Please fill in the form below and we will contact you to confirm an appointment day and time with you
Name

First Name Middle Name Last Name
E-mail
Gender
Date of Birth

Month Day Year
Contact Number:

Area Code Phone Number

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What are your outcomes for engaging in the coaching process?
If you could wish for any changes in your life what would they be?
What do you think is preventing you from achieving your goals?
I agree to receive marketing material about upcoming programs and special offers from Paul Mischel and/or Mindscape Consulting. *

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Coaching Commitment Terms and Conditions

Please read the following information carefully before submitting your form
This contract between Paul Mischel (the Coach) and (the Coaching Counterpart) provides the personal commitment of each party towards the success of the coaching encounter.

The Relationship
In agreeing to a coaching relationship, the Coach and the Coaching Counterpart understand that coaching:

May address specific projects, work performance, skill levels, and general conditions in the Coaching Counterpart’s profession or personal life.

Requires a co-active, collaborative approach. In the coaching relationship, the Coach plays the role of a facilitator of change, and it is the Coaching Counterpart’s responsibility to enact change and implement actions that have been agreed to between sessions.

Coach Commitments
Throughout the working relationship the Coach will:
- Engage in direct and personal conversations either face-to-face or by telephone, as jointly agreed between the parties.
- Determine with the Coaching Counterpart the most useful and desired outcomes.
- Apply contemporary Executive Coaching practices within the coaching relationship.
- Provide a safe, yet challenging learning environment for the Coaching Counterpart to promote exploration and discovery.
- Take a holistic, integral approach to coaching to ensure all required support is provided to the Coaching Counterpart.
- Seek feedback from the Coaching Counterpart and review coaching outcomes achieved against the goals set.
Counterpart Commitments
Throughout the working relationship the Coaching Counterpart will:
- Set with the Coach, the interim activities to be carried out between coaching sessions and action these between sessions in order to obtain the full benefit from this coaching.
- Demonstrate a willingness to be actively involved and committed to coaching.
- Participate with an open mind and a readiness to move forward.
- Come prepared and on-time to all coaching sessions with interim activities completed.
- Give permission to the Coach to challenge and confront thinking, behaviours and feelings during the coaching sessions in support of development goals.
Ethics and Confidentiality

Any specific information discussed or issues raised during the course of your sessions will be on a strictly confidential basis.

Mindscape Consulting will maintain file notes on the progress of your sessions and will ensure complete confidentiality of this information, except in rare circumstances where decreed by law.

By clicking submit you agree to all terms and conditions.
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15 minute Complimentary Coaching Client Intake Form

Coaching Commitment Terms and Conditions