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Getting started with your coaching

Please take some time to consider and complete this information form. We will use this information to develop your coaching plan and assess your coaching fees (see last section of this questionnaire). Please submit the form to us at least three days before you wish your first coaching session to commence. (In addition please enclose a brief current resume if you have one.)


To complete the coaching form off-line, please click here to download the coaching form in PDF format.
Please complete the form and fax to +27 (866) 505927.


The coaching start form consists of three steps. Each step is a page with a number of questions to complete. Each page is saved separately so if you discontinue completing the form you may return later, enter your e-mail address as reference and continue the form. Note that only a page that has been saved by clicking on the continue button.


Please DO NOT press the Back button while filling in these forms.

Step 1 of 3

Your Details
First Name:
Family Name:
Mailing Address:
Country you live in:
Gender: Male Female
Home Phone:
Business Phone:
Cell Phone:
E-mail Address:
Marital status: Married:  Never married:   Divorced:   Widowed:  
Religion (optional):
Children’s names and ages:
Are you a business owner?: Yes:   | No: 
Do you work Freelance?: Yes:   | No: 
Do you want to start your own business?: Yes:   | No: 
Your Goals
Take a moment to think about what you most want to achieve then answer the questions that follow.

What are the three biggest changes you want to make in your life in the next 3 months?
What are the three biggest changes you want to make in your life in the next 3 years?
What do you most want to achieve and do you feel ready for it?
Your History
What would you say have been your 3 greatest accomplishments to date?
What is the hardest thing in your life that you have had to overcome?
Who are or have been your major role models?
Have you worked with a coach before or a similar one-on-one adult relationship (e.g. tennis coach, piano teacher, therapist)? Please give brief details
If you said yes above, what worked well for you and what did not work in the relationship(s)?
What major transitions have you had in the past two years? Entering or approaching a new decade, a new relationship, a new job, a new role, a new residence, change in children’s ages/stages, etc.?


Benefit of the many inspirational posts on Marc Steinberg´s Facebook page!




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