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UCLH pre-coaching evaluation form
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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?
*
Manager
Myself
Other
Please identify your current levels in these areas (1 = lowest, 6 = highest)
*
1
2
3
4
5
6
Motivation at work
1
Motivation at work 1
2
Motivation at work 2
3
Motivation at work 3
4
Motivation at work 4
5
Motivation at work 5
6
Motivation at work 6
Self-awareness at work
1
Self-awareness at work 1
2
Self-awareness at work 2
3
Self-awareness at work 3
4
Self-awareness at work 4
5
Self-awareness at work 5
6
Self-awareness at work 6
Self-confidence at work
1
Self-confidence at work 1
2
Self-confidence at work 2
3
Self-confidence at work 3
4
Self-confidence at work 4
5
Self-confidence at work 5
6
Self-confidence at work 6
Happiness at work
1
Happiness at work 1
2
Happiness at work 2
3
Happiness at work 3
4
Happiness at work 4
5
Happiness at work 5
6
Happiness at work 6
Which areas would you like to focus on in your coaching? (please select all that apply)
Self-awareness and self-management
Increasing self-awareness
Increasing self-confidence
Managing stress levels
Support during organisational change
Increasing resilience
Improving my work/life balance
Career development
Having clearer career goals
Transitioning into a more senior leadership role
Transitioning into an executive role
Working at board level
Leadership skills
Enhancing leadership skills
Improving communication skills
Enhancing leadership presence and impact
Developing system wide relationships and networks
Influencing without authority
Holding people to account
Leading and managing change
Other (please specify)
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