NEW CLIENT QUESTIONNAIRE
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Please provide responses to each statement: 1 (strongly agree) to 5 (strongly disagree)
I feel that I am capable of having the life I really want.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I am open to experimenting with new ways of doing things in my life.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I am willing to be disciplined and follow through with my commitments.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I am a positive person.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I hold myself fully accountable for the results I create in my life.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I have a clear vision for my life and what I am committed to accomplishing.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I do well when working with others.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I live with a high level of integrity.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I am supported by the people in my life and they are committed to my success.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I am committed to my own personal growth and am willing to invest the necessary time and energy.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
When I have a setback in life, I am able to bounce back quickly.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
I am able to receive support and contribution from others.
Please Select
1 Strongly Agree
2 Agree
3 Neutral
4 Disagree
5 Strongly Disagree
What influenced your decision to start working with a life coach?
Have you ever worked with a life coach before? If so, please describe your experience.
What part of your life is working well?
What part of your life could be working better?
What do you want to focus on first in your work with me?
What are some obstacles that keep you from achieving your goals?
What are your life values? What is most important to you?
What is success in your opinion?
If you knew you wouldn't fail, what would you love to do?
What is your biggest fear?
What is your biggest reoccurring complaint about yourself?
What are you biggest personal strengths?
What is your biggest personal weakness?
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