Coaching Client Questionnaire

Complete this form prior to your first coaching session.


  • Help us better understand your unique situation and goals for coaching. Please provide as much of the following information as you can regarding the person who has been diagnosed with Alzheimer’s or a related dementia, as well as important information about your individual needs and concerns as a care partner.

About you


About the person you are caring for


About your coaching needs



If you prefer, print this form and send in the mail instead of submitting online. It’s also handy to keep a copy of this form for your records.

Coaching Client Questionnaire (Printable PDF version)

Don’t forget to complete your Caregiver Coaching Agreement

New clients have two forms to fill out. If you haven’t completed your agreement, you can complete it now. Here’s a link.

Caregiver Coaching Agreement

Compassion Works, LLC enthusiastically engages care partners and organizations impacted by dementia through coaching, consulting, education and training, so they are empowered to effectively face challenges with confidence, clarity and connection.

We’d love to hear from you!

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