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16
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1
Date
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Date
Year
Month
Day
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2
Name
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First Name
Last Name
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3
Email
*
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example@example.com
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4
Coach
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1
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5
What were your goals for your coaching engagement?
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6
Were your goals met?
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YES
NO
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7
How has this coaching experience impacted you? As a leader? Overall?
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8
What behaviors, practices or resources did you find most helpful in the coaching engagement?
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9
What would have made your coaching experience more effective?
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10
What has been your most profound takeaway from your coaching experience?
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11
What would you say my gift(s) or strength(s) are as a coach?
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12
Was this your first time working with a coach?
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NO
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13
May we use your feedback in client testimonials?
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YES
NO
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14
May we use your First Name, Last Initial, City and State (e.g. Keisha G. - Dallas, TX) along with the testimonial?
YES
NO
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15
How would you rate your coach's performance in support of you and your coaching objectives on a scale of 1 to 5?
1
2
3
4
5
Subpar
Amazing
2
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16
How likely are you to recommend our coaching services to a friend or colleague?
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1
2
3
4
5
Not Likely
Very Likely
3
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17
Please provide any additional thoughts, critiques or feedback you may have.
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18
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