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Get Started with A lá Carte Coaching

As your coach, it’s important for me to get to know you personally. This is new and like nothing you’ve ever done before, and creates rapid, permanent results. Please complete the following questions to the extent that you are willing and comfortable. The more thought you put into responding to the questions, the more productive our work together will be. Please note that your responses, as well as all the work we do together as part of the coaching engagement, will always be held in complete confidence. No one other than your coach will see your answers and you will have the option to print them once filled in.

QUESTIONNAIRE

Name:

Mailing Address:

This address is:

home

work

Work Email:

Personal Email:

Which email do you prefer for our communication? Work or Personal?

Work Phone:

Cell Phone:

Company:

Department:

Role/Title:

Marital Status:

Spouse/Partner's name:

Birthday:

Children's names & ages:

Pets:

Leadership Background Information (leading yourself and/or others)

How long have you worked for your employer? Years months

How long have you been in your current role? Years months

# Direct reports # of Total reports

Budget Responsibility $

# of employees in organization Organizational Revenue

1) Tell me about your experience as a leader (i.e. how much experience do you have in a leadership role, what type of roles, span of control, etc.)

2) What do feel are your strengths or natural talents?

3) What do you enjoy most about your role?

4) What specific outcomes has your organization or someone else given you, or you’ve identified?

5) Identify up to 5 things you would like to accomplish through coaching. You are free to choose anything of significant importance to you. Many clients find it effective to set 1 business goal (metric measurable), 1 leadership goal (how I lead) and 1 personal goal at a minimum.

6) If six months from now we looked back on how much progress you made towards your goals, what would you have accomplished? How would I have played a role in helping you achieve those goals? Be specific.

7) What do you value about yourself that you want to bring more fully to your work or life?

Additional Background Questions:

1) What are you passionate about? What gets your blood pumping?

2) What is missing from your life that would make it more fulfilling?

3) Do you know what your life purpose is? If so, please state it here.

4) If you had a long-term goal and the continuing services of a coach to help you achieve it, what goal would that be?

5) What behaviors or habits do you fight? What blind spots or hot buttons keep you from success?

6) What is the impact of these behaviors, habits, blind spots, or hot buttons?

7) How will you know these behaviors have been overcome?

8) On a 1-10 scale, with 1 low and 10 high, where would you rate your level of willingness to work on and change your behavioral patterns, to achieve your goals?

9) Are you willing to be uncomfortable during the change process?

10) What else should I know about you to be most effective in helping you attain your goals?

Please complete and return this document at least 24 hours prior to our first meeting.

COACHING AGREEMENT

Please review this Coaching Agreement, sign where indicated, and return. It is important that you also review, acknowledge and agree to our Client Disclosure Form in connection with your engagement of Exponential Results.

Client Name:

Coach’s Name (if known at inception, otherwise one will be assigned):

How We Will Meet

Coaching sessions will be held via video conference or phone twice per month for 60 minutes per session, with action items and follow ups or check-ins in between. Ad-hoc meetings can be added as needed upon request to fully support your journey to Exponential Results.

Coaching Fee: $450/mo.

Payment

You may render payment by digital payment. Payments are due on the 1st of the month in which service is rendered, and no later than in advance of any services to be performed in that month.

Please note that payment with any type of credit card will incur the applicable, state-allowable processing fee, which will be added to the total cost of services.

Expectations and Obligations for Coaching Sessions

Client Obligations. As the Client, you acknowledge and agree to the following:

Make coaching sessions a priority. In the event that you need to reschedule your coaching session, you agree to provide at least 24 hours advance notice. If less than 24 hours’ notice is provided, the session will be forfeited with no refund. Bona fide emergencies will be considered on an individual basis.
Changes/Cancellations. In the event that you need to reschedule due to unscheduled travel or similar, we ask for as much notice as possible, in consideration of the coach's schedule. Likewise, your coach may also need to reschedule a session on occasion. They will provide you as much notice as possible and try to make rescheduling as convenient as possible.
Payment for monthly sessions. Payments for all sessions shall be made in accordance with the terms in this Coaching Agreement. You agree to pay all amounts due in the manner specified herein.
Disclosure of Trauma or Mental Health concerns. You agree to disclose any relevant trauma and mental health history, diagnosis, medication, concerns, or issues with your Exponential Results Coach at coaching engagement start.
Client Relationship and Use of Exponential Results’ Coaching tools. You agree to being a client of Exponential Results, which will directly engage the Coach to provide the agreed upon sessions and services to you. You shall not do anything to disrupt the relationship between Coach and Exponential Results without the prior consent of Exponential Results. You agree to communicate and use the coaching tools and applications provided by Exponential Results for all sessions and to seek assistance from the Coach or a specified Exponential Results administrative assistant if you have difficulty accessing any such systems.
Feedback. You are encouraged to provide feedback, if any, to your Coach or Exponential Results representatives during the coaching engagement. You also agree that representatives from Exponential Results may contact you occasionally to receive feedback or comments regarding the provision of services. If you provide suggestions, enhancement requests, recommendations, or other information regarding Exponential Results, including your coaching sessions, you agree to assign all rights, title and interest in such to Exponential Results, and all such feedback shall be deemed Exponential Results’ confidential information.

Coach Obligations. Coach and Exponential Results acknowledges and agrees to the following:

Confidentiality. The information you share with Exponential Results and your coach is confidential and Exponential Results and your coach will practice the highest industry standards to protect your confidentiality during the sessions. Your coaching sessions are personal to you and will not be shared with your employer or organization unless you direct otherwise. Exponential Results is committed to keeping your information confidential, and does not sell, rent, or lease contact information to third parties unless required by law.
Power Pathways Portal™. All coaching sessions, follow up, feedback, and scheduling will be conducted through an application authorized by Exponential Results. Currently, the authorized application is Power Pathways Portal™ (“PPP”). Your coach will ensure all session notes, scheduling, and other tools used for the sessions are communicated through PPP. You agree to enter and utilize the information (such as session schedule) in the portal, as it facilitates and supports your growth journey.

Renewal and Termination

We are confident you will be ecstatic about your leadership growth through coaching and that you will desire to continue just as other clients have. Therefore, this Coaching Agreement will auto-renew in six-month increments, unless you or Exponential Results gives 30 days’ notice on the first of the fifth (5th) month following the initial or renewed six-month term, as applicable.

Disclaimer

Exponential Results’ liability to you for damages arising out of this agreement shall be limited to direct damages and shall not exceed the amount of fees paid by you within the thirty days prior to the event giving rise to the claim or causing the damages. Exponential Results shall have no liability whatsoever for special, incidental, exemplary, punitive, multiple, consequential, or indirect damages (including lost profits, loss of data, loss of use) of you or any third party, whether based upon warranty, contract, tort, strict liability or otherwise, even if you have been advised of the possibility of such damages. Exponential Results disclaims all warranties, express or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose, title, and non-infringement.

Thank you

Thank you for entrusting Exponential Results with the opportunity to support you in coaching and to achieve your desired outcomes.

The parties agree to the terms herein:

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