Client Questionnaire
  • LIFE DASHBOARD PRO BY BRUILT™
  • LIFE DASHBOARD PRO BY BRUILT™
  • Client Information
  • GENDER*
  • MARITAL STATUS*
  • PRESENTLY LIVING WITH*
  • ANY CHILDREN?
  • PLEASE SELECT OPTIONS OF CONFERENCING FACILITIES AVAILABLE TO YOU*
  • COMPANY Information
  • HOW CAN WE HELP YOU?

  • TELL US ABOUT WHY YOU ARE SEEKING COACHING

  • WHAT ARE SOME OF THE GOALS YOU'D LIKE TO ACHIEVE?

  • GOALS
  • HOW DID YOU HEAR ABOUT US?

  • Please include any attachments for any other information that would help us better understand your needs.

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  • SELF MASTERY

  • I HAVE A STRONG SENSE OF WHO I AM AND WHAT I AM ALL ABOUT.
  • I KNOW WHAT MY CORE VALUES ARE AND CAN ARTICULATE THEM CLEARLY.
  • I HAVE A CLEARLY DEFINED PERSONAL VISION & MISSION STATEMENT THAT I TRY TO LIVE BY.
  • I AM CONFIDENT IN MY ABILITIES TO COPE WITH THE CHALLENGES OF LIFE.
  • I BELIEVE I AM DESERVING OF HAPPINESS.
  • I FEEL VERY MUCH IN CONTROL OF MY OWN LIFE.
  • I HAVE A HIGH LEVEL OF INTEGRITY BETWEEN WHAT I THINK, SAY AND DO.
  • I AM APPROPRIATELY SELF ASSERTIVE.
  • I BELIEVE IN MAKING THINGS HAPPEN IN MY LIFE VERSUS LETTING THINGS HAPPEN OR HAPPEN TO ME.
  • I DWELL FOR TOO LONG ON PAST MISTAKES.
  • I FORGIVE AND LEARN FROM MY MISTAKES AND MOVE ON POSITIVELY.
  • I AM A COMPASSIONATE PERSON.
  • I AM A SELF-MOTIVATED PERSON.
  • I HAVE THOUGHT DEEPLY ABOUT MY CHARACTER AND KNOW EXACTLY WHAT I WANT IN THIS AREA OF MY LIFE.
  • I HAVE A PERSONAL STATEMENT FOR MY LIFE VISION

  • SPIRITUAL GROWTH

  • I FEEL VERY FULFILLED AS A HUMAN BEING.
  • I HAVE A CLEAR SENSE OF MY PURPOSE IN LIFE.
  • I LIVE VERY CONSCIOUSLY AND PAY ATTENTION TO ALL AREAS OF MY LIFE
  • I CONTRIBUTE TO OTHERS AND MAKE THE WORLD A BETTER PLACE
  • I AM ACCEPTING OF ALL PARTS OF MYSELF, BOTH THE GOOD AND THE BAD
  • I AM VERY CONTENT MOST OF THE TIME
  • I AM ACTIVELY LOOKING FOR NEW IDEAS AND STRATEGIES FOR LIVING A BETTER LIFE
  • MY RELIGION OR SPIRITUAL PREFERENCE

  • EMOTIONAL INTELLIGENCE

  • I FEEL IN CONTROL OF MY EMOTIONS MOST OF THE TIME.
  • I AM JOYFUL AND HAPPY MOST OF THE TIME.
  • I AM SELDOM DEPRESSED OR LOW.
  • I HAVE A CONSISTENTLY GREAT ATTITUDE TOWARDS LIFE.
  • I SELDOM EXPERIENCE GENERALISED STRESS OR ANXIETY.
  • I CAN CLEARLY DEFINE THE EMOTIONS THAT ARE MOST IMPORTANT AND DESIRABLE TO ME.
  • I HAVE A VERY HAPPY UPBRINGING.
  • I VIEW THE WORLD AS A GOOD PLACE.

  • LOVE & RELATIONSHIPS

  • DO YOU THINK ABOUT THE VARIOUS LEVELS OF RELATIONSHIPS AND HOW YOU FIT INTO THESE? PLEASE SELECT THOSE APPLICABLE.
  • I HAVE A GOOD AND DEEP SPIRITUAL RELATIONSHIP WITH GOD OR THE INFINITE INTELLIGENCE.
  • I HAVE A GOOD AND HEALTHY RELATIONSHIP WITH MY PARENTS.
  • I HAVE A GOOD AND HEALTHY RELATIONSHIP WITH MYSELF – I AM VERY MUCH SELF-ACTUALISED.
  • I HAVE A GOOD UNDERSTANDING OF HOW I FIT INTO SOCIETY | COMMUNITIES | MY WORK & CAREER.
  • I HAVE A HEALTHY AND GOOD INTIMATE RELATIONSHIP WITH THE OPPOSITE SEX OR MY PARTNER.
  • I WOULD LIKE A HEALTHY AND GOOD INTIMATE RELATIONSHIP WITH THE OPPOSITE SEX OR MY PARTNER.
  • I TAKE CONSISTENT ACTION TO FIND MY IDEAL PARTNER.
  • I HAVE A CLEAR PICTURE OF WHAT MY IDEAL PARTNER WOULD BE LIKE.
  • I KNOW I WILL MAKE A GREAT PARTNER SOMEDAY.
  • I HAVE A VERY SATISFYING SEX LIFE
  • I HAVE THOUGHT DEEPLY ABOUT THIS AREA OF MY LIFE AND KNOW EXACTLY WHAT KIND OF A RELATIONSHIP I WANT TO BUILD.

  • HEALTH & FITNESS

  • I AM VERY HAPPY WITH THE WAY MY BODY LOOKS & FEELS.
  • I HAVE A CLEARLY DEFINED EXERCISE PROGRAMME AND I STICK TO IT DILIGENTLY.
  • I HAVE AN EXCELLENT, HEALTHY DIET.
  • I HAVE THOUGHT DEEPLY ABOUT MY HEALTH AND FITNESS AND KNOW EXACTLY WHAT I WANT IN THIS AREA OF MY LIFE.
  • I HAVE EDUCATED MYSELF REGARDING HEALTH AND NUTRITION.
  • I LOOK AND FEEL YOUNGER THAN MY TRUE AGE.
  • I HAVE A CONSISTENTLY HIGH ENERGY LEVEL.
  • I AM HAPPY WITH MY CURRENT WEIGHT
  • I WOULD LIKE TO WORK TOWARDS MY IDEAL WEIGHT
  • SMOKING

  • INTELLECTUAL DEVELOPMENT

    YOUR GIFTS AND TALENTS
  • I FEEL QUITE CONFIDENT IN MY INTELLECTUAL ABILITIES.
  • I PUSH MYSELF MENTALLY AND STRETCH MY INTELLECTUAL ABILITIES EVERY DAY.
  • I HAVE A STRATEGY IN PLACE TO KEEP MYSELF LEARNING AND GROWING.
  • I CONSISTENTLY LOOK TO PERSONAL DEVELOPMENT PRODUCTS TO ENHANCE MY LIFE.
  • I HAVE THOUGHT DEEPLY ABOUT MY INTELLECTUAL LIFE AND KNOW EXACTLY WHAT I WANT IN THIS CATEGORY.
  • I FEEL FULFILLED INTELLECTUALLY.

  • CAREER & ENTREPRENEURSHIP

    HOW TO USE YOUR GIFTS AND TALENTS
  • MY PRIMARY OCCUPATION IS:
  • MY CAREER IS VERY FULFILLING TO ME – I LOVE WHAT I DO.
  • MY CAREER CHALLENGES ME AND KEEPS ME LEARNING AND GROWING.
  • I SELDOM EXPERIENCE CAREER STRESS.
  • I WAKE UP EACH MORNING LOOKING FORWARD TO MY WORK.
  • I AM VERY GOOD AT WHAT I DO.
  • I WOULD LIKE TO RUN MY OWN BUSINESS.

  • FINANCIAL INTELLIGENCE

    MANAGING MONEY
  • I MANAGE MY MONEY WELL.
  • I SELDOM EXPERIENCE FINANCIAL STRESS.
  • I HAVE CLEAR, WRITTEN FINANCIAL GOALS.
  • I DEEPLY UNDERSTAND THE FUNDAMENTALS OF WEALTH CREATION.
  • I BELIEVE THAT MAKING MONEY AND CREATING WEALTH ARE VERY GOOD THINGS.
  • MY FINANCES ARE HIGHLY ORGANISED.
  • MY PERSONAL & BUSINESS LIVES ARE HIGHLY ORGANISED (INSURANCE, ESTATE PLAN, ETC.).
  • I FEEL THAT I HAVE A HIGH LEVEL OF FINANCIAL SECURITY IN MY LIFE.
  • I FEEL THAT I HAVE A HIGH LEVEL OF FINANCIAL SECURITY IN MY LIFE.
  • I HAVE THOUGHT DEEPLY ABOUT MY CAREER AND KNOW EXACTLY WHAT I WANT IN THIS AREA OF MY LIFE.
  • I WISH TO CHANGE CAREER.
  • I DO NOT WISH TO CHANGE CAREER.
  • I WOULD LIKE TO BE FINANCIALLY INDEPENDENT

  • SOCIAL INTERACTION

  • OVERALL, I HAVE A CLOSE, LOVING RELATIONSHIP WITH MY SIBLING/SIBLINGS.
  • I HAVE A FANTASTIC, ACTIVE SOCIAL LIFE.
  • I HAVE FRIENDS I CAN ALWAYS COUNT ON TO BE THERE FOR ME.
  • I INVEST A GOOD DEAL OF TIME AND ENERGY IN MY FRIENDS.
  • I INVEST A GOOD DEAL OF TIME AND ENERGY IN MY FRIENDS.
  • I PAY CLOSE ATTENTION TO THE RELATIONSHIPS THAT NOURISH ME, VERSUS THE RELATIONSHIPS THAT DRAIN ME.
  • I CONSIDER MYSELF TO BE A VERY GOOD FRIEND TO OTHERS
  • I HAVE THOUGHT DEEPLY ABOUT MY SOCIAL LIFE AND KNOW EXACTLY WHAT KIND OF FRIENDSHIPS I WANT TO BUILD.

  • FAMILY LIFE & PARENTING

  • I HAVE XXXX CHILDREN
  • I PLAN TO HAVE CHILDREN
  • IF YOU DO NOT HAVE CHILDREN YET….. I WOULD LIKE TO HAVE CHILDREN SOMEDAY.ANSWER THIS QUESTION AND SKIP ALL OTHER QUESTIONS IF YOU DO NOT YET HAVE CHILDREN
  • I HAVE A CLOSE, LOVING, HEALTHY RELATIONSHIP WITH MY CHILDREN.
  • I RARELY EXPERIENCE ANXIETY WITH REGARD TO MY CHILDREN.
  • I SET A GREAT EXAMPLE FOR MY CHILDREN OF HOW TO LIVE A WONDERFUL LIFE.
  • I HAVE A CONSCIOUS, CLEARLY DEFINED PARENTING STRATEGY.
  • I AM VERY PLEASED WITH HOW MY CHILDREN ARE TURNING OUT AS PEOPLE.
  • OVERALL, I FEEL LIKE I AM A FANTASTIC PARENT.
  • I HAVE THOUGHT VERY DEEPLY ABOUT THE TYPE OF PARENT I WANT TO BE AND CONTINUE TO MAKE IMPROVEMENTS.

  • QUALITY OF LIFE

  • I LOVE THE HOUSE I LIVE IN.
  • I WOULD LIKE TO BUILD A “HOME” NOT JUST LIVE IN A HOUSE.
  • MY HOME PROJECTS THE FEELINGS THAT ARE MOST IMPORTANT TO ME (LOVE, PEACEFULNESS, SENSUALITY, FUN,CLEANLINESS, SERENITY, BRIGHTNESS, COMPASSION AND JOY).
  • I HAVE THOUGHT DEEPLY ABOUT MY QUALITY OF LIFE AND DEFINED EXACTLY WHAT I WANT IN THIS AREA.
  • I HAVE THOUGHT DEEPLY ABOUT MY QUALITY OF LIFE AND DEFINED EXACTLY WHAT I WANT IN THIS AREA.
  • I DESERVE THE BEST THAT LIFE HAS TO OFFER.
  • I TAKE REGULAR BREAKS AND VACATIONS.
  • I HAVE A LOT OF FUN IN MY LIFE.
  • I FEEL THAT I AM TRULY LIVING MY BEST LIFE TO THE FULLEST.
  • I PLAN EXTRAORDINARY EXPERIENCES FOR MYSELF ON AN ONGOING BASIS (TRIPS, EVENTS, AND OTHER HIGHLY MEMORABLE MOMENTS).
  • I AM SATISFIED WITH THE QUALITY OF MY POSSESSIONS (CARS, FURNITURE, ARTWORK, DISHES OR ANY OTHER MATERIAL THINGS IN MY LIFE.

  • THE BRUILT™ LIFE VISION BOARD

    YOUR VISION BOARD FOR SUSTAINABLE LIFE
  • I HAVE A VISION FOR MY LIFE AND I WORK ON THAT REGULARLY.
  • I HAVE A STRONG SENSE OF HOW I WOULD LIKE MY LIFE TO UNFOLD OVER THE COMING YEARS.
  • I INTEND TO INVEST IN MY OWN PERSONAL DEVELOPMENT IN THE COMING YEARS.
  • I KNOW HOW MUCH MONEY I WOULD LIKE TO BE MAKING IN FIVE YEARS FROM NOW.
  • I CURRENTLY HAVE A PLAN IN PLACE FOR ACHIEVING MY GOALS AND MY IDEAL LIFE.
  • I HAVE A ONE YEAR | TWO YEAR | THREE YEAR | FOUR YEAR | FIVE YEAR PLAN
  • I CAN CLEARLY DEFINE MY SINGLE MOST IMPORTANT GOAL IN LIFE.
  • I BELIEVE HUGE TRANSFORMATIONAL SHIFTS ARE POSSIBLE IN MY LIFE.
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