New Client Questionnaire

            Welcome to Your BEST YOU!!






  New Coaching Client Questionnaire

First Name
Last Name
Email Address

I'm excited to partner with you to achieve your goals.
So that I can be a little more prepared when we meet, please share briefly with me how I can assist you to be your Best you?  What's your challenge and what can I help you achieve?

Have you set a goal completion or achievement date?  If yes, what is your date?  If no, we can schedule a date in our first few coaching conversations.

What is your goal date?

As your Coach, there are areas where I will be the best support to achieve your goals.  There are also areas where you might be better served by a different professional.  I want to ensure that you receive the support you want and need.

Coaching is

As your Personal Development Coach, I will advise, guide, and assist you in the achievement of self-determined personal goals and objectives.  Achievement of your goals will require commitment from you to actively engage, keep scheduled appointments, and complete assignments (where applicable) between Coaching Conversations.  I will provide support, encouragement, cognitive behavior techniques, and accountability so you can achieve your growth and success.  Coaching Conversations will be scheduled in advance, in 30-minute or 60 minute or 90-minute increments, and will be conducted by phone or online.  A contact phone number or internet link will be provided for coaching conversation appointments and you'll need access to a camera for an online video conversation.  If you don't have a camera on your laptop or tablet, a cell phone is great too!

Coaching is NOT

If you need a different professional such as an employment agent, financial analyst, psychotherapist, or business manager, I am not the professional you need.  I will not promise, shall not be obligated to, and will not attempt to obtain employment, business, or sales or provide therapy for psychological counseling, psychoanalysis therapy.

Your Confidentiality

Your Personal Development Coaching Conversations could include the sharing of private and personal information. All information shared in Coaching Conversation will ALWAYS be kept confidential and will NOT be shared verbally or in writing with anyone except where required by law.  Coaching Conversations will NOT be recorded unless you and I have agreed, in writing, before the coaching conversation.  My privacy policy link.


Coaching services are provided on a retainer basis and paid before the coaching appointment.  Payments will be made electronically through Paypal or Square.  For monthly payments, any payment that has NOT been made by the 6th of each month will result in the cancellation of this agreement and subsequent appointments canceled.

Coaching Agreement of Services

You and I have agreed to work together for the achievement of self-determined goals and objectives.  Our Coaching Conversations will be pre-scheduled appointments Monday through Friday for the duration of our coaching agreement. To ensure you achieve your goals, all coaching agreements are a minimum of 12 conversations over 90 days. Cancellation and rescheduling require an email notification 24 hours before the appointment date.   Coaching appointments will be rescheduled at the next available date for you and me.

I accept the terms listed above to enter into a coaching agreement with Pamela Burks as my personal development coach.  My agreement is confirmed by my ACCEPTance of the coaching terms, payment terms, and fees of this agreement.

Contact Information

In the event you need to send information, assignments, or re-schedule an appointment, my contact information is listed below.

Phone: (407) 900 0795 
Correspondence only:
5885 Cumming Hwy
Suite 108-112
Sugar Hill, GA 30518

Have you scheduled your Coaching Appointment yet?
Schedule Appt

You've completed the questionnaire! CONGRATS! 
I'm looking forward to our Coaching Conversation!