UCLH pre-coaching evaluation form

Name *

First

Last

What are the biggest challenges you face right now? *

What would you like to achieve by starting a coaching relationship? *

How will you know you have achieved it? *

Whose idea was it to get a coach? *

Please identify your current levels in these areas (1 = lowest, 6 = highest) *

	1	2	3	4	5	6
Motivation at work	1Motivation at work 1	2Motivation at work 2	3Motivation at work 3	4Motivation at work 4	5Motivation at work 5	6Motivation at work 6
Self-awareness at work	1Self-awareness at work 1	2Self-awareness at work 2	3Self-awareness at work 3	4Self-awareness at work 4	5Self-awareness at work 5	6Self-awareness at work 6
Self-confidence at work	1Self-confidence at work 1	2Self-confidence at work 2	3Self-confidence at work 3	4Self-confidence at work 4	5Self-confidence at work 5	6Self-confidence at work 6
Happiness at work	1Happiness at work 1	2Happiness at work 2	3Happiness at work 3	4Happiness at work 4	5Happiness at work 5	6Happiness at work 6

Which areas would you like to focus on in your coaching? (please select all that apply)

Self-awareness and self-management

Career development

Leadership skills

Other (please specify)