New Client Questionnaire

Feel free to leave blank any questions you believe are irrelevant to our work together or which you can't readily answer. Please email your responses to Dr. Sally Gelardin.

Name:

Address:

Phone:

e-mail:

Date of birth:

Today's date:

What, if anything, would you like to accomplish in each of these areas:

Your career:

Your relationships:

Your financial well-being:

Your recreation life:

Your mental well-being:

Your spiritual life:

What is/was your most recent job?

What did you like and not like about it?

List college(s) you attended, degrees received, major, and approximate grade-point average.

List any test results (e.g., SAT, GRE, Myers-Briggs, Strong-Campbell, etc.)

List the name, age, sex, and relationship to you of each person who presently lives with you. Are they having any impact on your career?

YOUR INTERESTS

If you were to write a book, what would it be about?

What subject do you most enjoy talking about?
If I looked around your room, what clue might I derive about your interests?

What's an unusual interest of yours?

At work, what do you enjoyably spend a lot of time on?

Outside of work, what do you enjoyably spend a lot of productive time on?

What items do you save?

What was your favorite subject in school?


YOUR ABILITIES

Which one or two of these are you: a) a word person, b) a math/science person, c) a people person, d) an artistic person, e) a fix-it, build-it person, f) a paperwork details person?

What kinds of problems at work do you solve well?

What kinds of problems at home do you solve well?

What do people ask your advice about or help with?

What have people complimented you on that might have career implications for you?

What does your family think you should do careerwise?

What do you find easy that many people find hard?

What task(s) has brought you the most success?

What's an unusual ability(ies) of yours?

List your life's five favorite completed projects or accomplishments. Not only did they turn out well, you enjoyed the process of completing the work. If you can't think of five from adulthood, go back as far as you want.

Do you know a wealthy, well-connected, eminent, or highly skilled person who could open an interesting career door for you?

WHAT YOU VALUE

If you didn't care what anyone thought, what is your most deeply held aspiration?

In what way does your behavior not match your true values?

What are the non-negotiables in your next job?

Where do you picture yourself working: an office, at home, outdoors, a school?

How many hours a week is the most you're willing to work?

What is the longest commute you would accept?

Must your work "make the world a better place"?

How pleasant must your work environment be?

Is there a product or service that makes you so unhappy you'd like to do something about it?

Is there an aspect of society that makes you so unhappy you'd like to do something about it?

What's an unusual value(s) you hold?

Write a paragraph describing what you'd like your life to be like five years from now.

YOUR PSYCHOLOGICAL ISSUES

What truly motivates you: money, praise, status, laziness, anger in general, anger about something specific, social injustice, glamour, multi-senses (visual/sound, aroma/kinesthetic/taste), creative expression, something else?

To what extent are any of the following impeding your career: procrastination, depression, fear of failure, anxiety.

If you've been in therapy or seen a career counselor previously, what were the results?

Right before you go to sleep and right when you wake in the morning, is there one topic you think about more than others?

What's something you're afraid is true about yourself?

What's your fatal flaw?

What do you want? What do you really want?

What keeps you from getting it?

(Intake Form based on Nemko, 2007)