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Client Intake Form

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Client Intake Form

05/01/2023

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Question 1 of 13

1. Question
This is a quick survey to help me understand your goals so I can help you reach them.

Fill in the blank:

Why did you reach out to Moxie? Why Now? ________________________.
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Question 2 of 13

2. Question
What are your top three goals for the coaching engagement?
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Question 3 of 13

3. Question
How confident are you with your public speaking skills today?
- 12345678910
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Question 4 of 13

4. Question
Have you ever received any feedback about your speaking that we should know about? If so, what?
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Question 5 of 13

5. Question
When the coaching engagement is over, how would you like to transform as a speaker?
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Question 6 of 13

6. Question
What, if any, are your concerns about the coaching engagement?
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Question 7 of 13

7. Question
Have you ever worked with a coach or a trainer that you enjoyed? If so, what about that coach’s personality, approach or method resonated with you?
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Question 8 of 13

8. Question
If you are able to accomplish your speaking goals following the coaching engagement, how will this benefit you in your personal and/or professional life?
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Question 9 of 13

9. Question
Are there any video recordings of you speaking that we should view prior to the coaching engagement (yes/no). If so, please send them in a separate email to your coach.
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Question 10 of 13

10. Question
Is there anything else that your coach should know about you at this time?
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Question 11 of 13

11. Question
Rate your overall effectiveness as a speaker.
- 12345678910
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Question 12 of 13

12. Question
Describe the makeup of your audience (who, demographics, purpose/goals, what’s in it for them, company, event, topic/focus area, etc.)?
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Question 13 of 13

13. Question
Please identify your desired areas of focus (choose all that apply).
- Content creation
- Organize my ideas into a logical flow
- Storytelling
- Nerves, stage fright and stress management
- Confidence and executive presence
- Pre-speech mental and physical preparation
- Concentration
- Energy management
- Fix the "I perform well in practice, but not during the presentation"
- Improve rehearsal efficiency and effectiveness
- Memorization techniques
- Deal effectively with the media
- Present "on the fly" better
- Vocal variety and non-verbal communication skills
- Vocal hygiene and vocal care
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