BetterMen High Performance Coaching Sign Up Form

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Instructions:

Whatever is written in this questionnaire and subsequently discussed with Dan in the private call are done so in the strictest of confidence.

Despite how uncomfortable the truth may be, the more open and transparent you are here, the more understanding you gain from what is holding you back from the life and what you will need to change to bridge the gap from where you are to where you want to be.

If a question is difficult to answer for you, perhaps it's because you're overthinking or trying to think too hard. Instead, I would encourage you to try writing what you feel.

The questionnaire should take around 30 minutes to complete. If now isn't a suitable time, come back to it when you have more space or less distractions.

And remember, you cannot become the man you want to be whilst remaining who you are...
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Full Name* This field is required.
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Phone Number* This field is required.
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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American Samoa
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The Bahamas
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Denmark
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El Salvador
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Falkland Islands
Faroe Islands
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Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Libya
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Madagascar
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Maldives
Mali
Malta
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Martinique
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Mauritius
Mayotte
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Moldova
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
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Northern Mariana
Norway
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Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
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Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
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Samoa
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Other
Country
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Best Email* This field is required.
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Occupation* This field is required.
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Marriage Status* This field is required.You may select more than one option
Married
Living with Partner
Divorced
Single
Widowed
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Date of Birth* This field is required.Ensure you click on the tick to save date entry
Date
Month
Day
Year
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Your Life: Please rate yourself in the following areas of your life on a scale of 1 (Lowest) to 10 (Highest)...
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Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?* This field is required.
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Energy: Do you consistently have enough mental and physical energy needed to accomplish your goals and to feel both motivated and happy?* This field is required.
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Courage: Are you assertive, do you take action and consistently express who you are, what you think and need?* This field is required.
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Productivity: Are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities?* This field is required.
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Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?* This field is required.
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Life Questions: Please consider each question carefully answering them with honesty and truth.
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What major stresses or challenges are you facing right now?* This field is required.
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When you consider the stresses or challenges you're experiencing, what do you believe to be the causes of them?* This field is required.
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When you feel life your most successful and happy self, what is happening/what are you doing that makes you feel that way?* This field is required.
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What are the key factors creating your current experience of life?* This field is required.
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What 3 big changes would you like to make in your life in the next 12 months and WHY are you committed to doing so?* This field is required.
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If you had to define your definition of success, what would you say?* This field is required.
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High Peformance Questions: Please consider each question carefully answering them with honesty and truth.
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What negative recurring thoughts, behaviours or beliefs would you need to overcome to feel more free, confident and successful?* This field is required.
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What habits could you like to begin OR break in order to begin living the life you want?* This field is required.
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What distracts you the most from being more productive, and what major projects are you struggling to complete?* This field is required.
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How purposeful do you feel in living each day, and how would you describe your purpose?* This field is required.
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If you were more influential, what goal or aspiration would you ask others to support you in achieving?* This field is required.
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If you had to describe in only 3 words how you feel about your current life, what words would you use and WHY?* This field is required.
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When you look at your life as it is, what changes might you be resisting?* This field is required.
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What do you LIKE about yourself and what do you DISLIKE about yourself?* This field is required.
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If you join Better Yourself Course is successful, what do you truthfully want from the course and what will you have to change to achieve it?* This field is required.
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Thank you for filling out this questionnaire. Simply hit submit to send this to BetterMen Coaching.
Should be Empty:

Better Yourself Course Pre-Questionnaire

Instructions:

Your Life: Please rate yourself in the following areas of your life on a scale of 1 (Lowest) to 10 (Highest)...

Life Questions: Please consider each question carefully answering them with honesty and truth.

Thank you for filling out this questionnaire. Simply hit submit to send this to BetterMen Coaching.