J. O'Brien Coaching - Client Intake Form

Contact

Engagement

Impact

Expectations

Stakeholders

Assessments

Additional Info

Confirmation

Section 1 of 8

Please complete this form to help us understand your context, priorities, and expectations. This information allows us to design work that is relevant, rigorous, and worth investing your time.

Estimated time to complete: 15 - 20 minutes

If there is anything urgent or specific you would like to discuss, please book time to connect or email jamie@jobriencoaching.com.

Contact & Demographics

Full Name *

Preferred Name *

Email *

Name of your Organization *

Business Address *

Industry of Business *

Professional Role Title / Function *

Phone Number Including Country Code *

Preferred Method of Communication *

Phone

Text Message

Other

Engagement Focus & Objectives

What type of engagement are you most interested in? * Select all that apply

Executive & leadership coaching (one-on-one coaching)

Team coaching (formal organizational teams or project teams)

Career transition coaching (securing / starting your next role internal or external of current org.)

Group coaching (cohort-based coaching aligned to a program to develop specific skills)

Mentoring for enhanced leadership development

Talent & succession planning

Talent / Organizational development strategy & planning

What leadership challenges or development goals would you like to focus on?

Please describe the team, including approximate size, function, and the primary team challenge or opportunity.

What is your target role, timeline, and any key constraints (e.g., geography, industry, level)?

Please briefly describe the scope, number of roles or people involved, and the business driver behind this initiative.

What challenges are you currently facing that you hope to address through this engagement? *

What do you believe you personally need to change, strengthen, or let go of for this engagement to be successful? *

What values or principles do you want to lead by, even under pressure? *

Impact & Outcomes

The following questions are intended to clarify impact, urgency, and success criteria.

What is this costing you? * Consider professional, personal, financial, and relational costs.

What specific outcomes do you want to achieve? * Please provide as many details as possible.

What key metrics or indicators of success should we track? * Select all that apply

Observed improvement of team performance

Feedback from peers / other leaders of improved leadership capabilities

Achievement of specific business / professional milestones

Demonstrated increase of leadership confidence presence or influence

Attainment of a specific role / promotion

Develop career transition toolkit (resume LinkedIn profile interview prep kit etc.)

Developing and formalizing talent strategy pipeline or succession plans

Other

What is the cost of inaction? * Are there any time-sensitive goals, deadlines, or events influencing this engagement?

How is this affecting your professional opportunities and / or quality of life? *

What will be different in how you think, decide, or act once these objectives are achieved? *

Stakeholders, Sponsorship, & Investment

Who are the stakeholders to involve in this engagement? * (e.g., your direct leader, HR business partner, peers, members of your team, executive leaders, clients, etc.) Please list by name and title. If none, simply note 'none'.

Will this engagement be funded by you directly (out-of-pocket) or sponsored by your organization? *

By me directly paying out-of-pocket

Additional Information & Context

Are you interested in completing other assessments to better help you uncover opportunities and success indicators for your engagement? *

Yes

Possibly | I would like more information and to discuss this

Which assessments interest you, or what aspects of your leadership would you like to explore further?

What questions do you have about potential assessments?

What concerns, hesitations, or past experiences might get in the way of fully engaging in this process? *

What questions do you have about the coaching process or this engagement that you would like to discuss during our first conversation? *

What other background information about you, your stage in life or your career, your team, or your organization should we know? *

What prompted you to explore coaching or consulting support at this time? *

Confidentiality & Confirmation

All information shared within this form remains confidential between J. O'Brien Coaching and you, the client.

Information contained within this form may only be shared with third parties if written permission is obtained from you, the client, in advance.

In organizationally sponsored engagements, themes from provided information may be shared at a high level with sponsors only as necessary to support the engagement and only with consent.

I understand that meaningful change and transformation requires effort, reflection, and action, and I commit to actively engaging in this process. *

I affirm that the information provided is accurate, to the best of my knowledge, and understand that it will be used to design a tailored engagement. *

Thank You!

Your intake form has been successfully submitted. We received your comprehensive information and will review it carefully.

You will hear from J. O'Brien Coaching within 1-2 business days to schedule your initial consultation and discuss the next steps of your coaching engagement.