Because its Your Life

Life and Career Coaching with Joan Steidl

Personal Information Form

Please know that all personal information is confidential and treated appropriately.

If you are ready to begin coaching, please do one of the following at least 4 days prior to our initial session:

  1. Download, complete and email this word document to Joan

  2. OR

  3. Download, complete and email this pdf document to Joan

  4. OR

  5. Complete the following form on-line and click submit at the end of the form:

Name: Gender:

Home Address:

City: State: Zip:

Home Phone (including area code): OK to leave a message?:

Work Phone (including area code): OK to leave a message?:

Cell Phone (including area code): OK to leave a message?:

At which number am I most likely to be able to reach you?

E-mail that you check daily:


Briefly explain what your job entails:

If employed, employer:

Birth date (including year):

Primary Relationship and name (e.g. Sue, wife/life partner):

Spouse/partner's birthday:

Names/Ages of Children (if applicable):

Please answer the following questions either in writing or be prepared to discuss them during our first coaching session:

Why are you choosing to begin coaching now? (if applicable):

What are you hoping to accomplish through coaching? (if applicable):

How will you know when you have reached your goal for coaching?(if applicable):

Highlighted fields are required.