Welcome to your next chapter!
Clarity • Growth • Purpose • Accountability
Thank you for choosing Totally Katika Life Coaching. This questionnaire is an opportunity for you to reflect on where you are, where you want to go, and what support would help you move forward.
There are no right or wrong answers. Please be as open and honest as you feel comfortable being. Your responses will help us make our coaching sessions more intentional and relevant to your goals.
Estimated completion time: 10–15 minutes
Complete your questionnaire
Use the Google Form below when Katika asks you to complete intake. A Google account is not required. Share only what you feel comfortable sharing; only your first name, last name, and email are required.
Submitting intake does not sign your coaching agreement or confirm enrollment. Agreement signing is a separate step. For help, email hello@totallykatika.com.
Before sharing your answers, read our Privacy Policy, including how Google Forms handles information. Share only what you are comfortable providing.
Having trouble with the embedded form? Complete intake directly in Google Forms.
Review the questionnaire wording before you begin
This is a read-only preview of the questionnaire wording. Enter and submit your answers in the Google Form above or use its new-tab link.
Part 1. Client information
Complete the fields below to prepare your personalized intake responses. Fields are optional unless marked required.
First name *
Last name *
Email address *
Phone number
Pronouns (optional)
Preferred method of contact
Phone
Text message
Occupation or current life role (optional)
How did you hear about Totally Katika Life Coaching?
Part 2. Your coaching goals
Select all areas you would like to explore.
Confidence and self-worth
Personal development and self-awareness
Healthy boundaries and communication
Relationships and connection
Purpose and life direction
Career or business growth
Habits, routines, and self-care
Accountability and goal achievement
Faith and spiritual growth
Life transitions and new beginnings
Other
1. What inspired you to seek coaching at this point in your life?
2. If coaching is helpful, what would you like your life to look or feel like six months from now?
Part 3. Your values and priorities
Your values help guide your decisions and the life you want to build.
Faith
Family
Authenticity
Peace
Personal growth
Health and wellness
Freedom
Integrity
Love and connection
Purpose
Financial stability
Service to others
Courage
Respect
Other
3. Which three values are most important to you right now, and why?
Part 4. Challenges and opportunities for growth
Share only what you feel comfortable discussing. You do not need to disclose anything you are not ready to share.
Difficulty prioritizing myself
Fear of failure or judgment
Difficulty setting boundaries
Self-doubt or negative self-talk
Inconsistency with goals
Feeling stuck or lacking direction
Difficulty navigating relationships
Major life changes
Balancing competing responsibilities
Other
4. What personal strengths or past experiences can help you move forward?
5. What do you feel has been getting in the way of the changes you want to make?
Part 5. Your support needs
Clarity and direction
Encouragement and confidence-building
Practical tools and strategies
Consistent accountability
A safe space to reflect
Help breaking goals into smaller steps
Support with routines and follow-through
Faith-centered reflection, if desired
Other
6. What does accountability look like to you? What kind of encouragement or follow-up helps you stay committed?
7. How will you know that coaching is making a positive difference in your life?
8. What do you hope to receive from me as your life coach?
Part 6. Faith and personal reflection
Faith is personal. Please select the approach that feels right for you; there is no preferred answer.
I would like faith and spiritual growth incorporated into coaching.
I am open to discussing faith when it feels relevant to my goals.
I prefer coaching to focus on personal growth without a faith emphasis.
Is there anything else about your beliefs, values, or personal growth journey you would like me to understand? (Optional)
Part 7. Final reflection
9. What is one thing you are ready to change, release, learn, or embrace?
10. Is there anything else you would like me to know before our first session?
Client acknowledgment
Please review the following before submitting your questionnaire.
I understand that this questionnaire helps prepare for coaching and does not replace a coaching agreement. I understand that coaching supports my own reflection and decisions, and that confidentiality and its limits will be explained in my coaching agreement.
Ready for your next step? Complete the form above when Katika asks you to, then follow the instructions she shares for your coaching agreement and first session.
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