Coaching Questionnaire

Let’s get started:

Please take the opportunity to answer the questions below to the best of your ability to secure your free 30-minute consultation.The more thoughtful and detailed information you provide, the better we can serve you. It’s our mission to close the gaps between where you are today and where you want to be tomorrow.

*First & Last Name:

*Email:

City & State

*Age:

Self Reflection

1) In order to get a fingerprint on “who you are,” please provide a brief description of yourself. For example: Are you head of a sales operation? Are you a college graduate/dropout? Are you a risk taker? Do you define yourself by your job title, relationship status or belief system? How was your upbringing or current family situation? Do you compare yourself to others? How do you view the world?

2) Which of the following answers best describe your personality?


3) What Top 5 things are you most proud of?

4) What major life changes have you experienced in the last several years (e.g., the death of loved one, new or ending relationship, surgery, changing job, moving, etc.)?

5) What are your deep-rooted core wounds? What limitations have they created in your life?

Present Moment

6) What are your needs (things you can’t live without)? What are your wants (things you would like to have if possible)?

7) What are your strengths? What are your weaknesses?

8) What bad habits, behaviors or toxic waste (e.g., negative influences, relationships, jobs, self-judgment, negative thoughts, self-doubt, criticism from others, etc.) are hampering your ability to succeed personally or professionally? What are you willing to do about it?

9) What’s working well in your life right now? What’s not working so well in your life right now?

10) What’s currently keeping you awake at night? Or what challenges are you facing?

Future Aspirations

11) What are the three most important goals you’re trying to accomplish within the next year? And does your current environment support you towards achieving these goals?

12) What’s emotionally driving you towards achieving these goals? How will life change as a result of achieving these goals?

13) What will bring you more satisfaction and fulfillment in your life? What have you done this past month to attain it? What will you do going forward to get it?

14) What changes would you like to make in your life over the next three months?

15) On a scale of 1 – 10, how would you describe your level of commitment and accountability to change your life?

16) Why is now the time to take action and have a coach?

17) Have you ever worked with a coach? If so, how was your experience? What
positive and negative takeaways do you remember?

18) What would you like to achieve with your new coach?

19) Are there any additional topics not covered in this questionnaire you’d like to discuss?

20) What’s your preferred method of contact (e.g., Skype, FaceTime, WhatsApp or in person)?

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