Individual Coaching Susan Denee

INDIVIDUAL COACHING ASSESSMENT

Goal: This short assessment aims to help you gauge the level of satisfaction you are living your life. It's easy to slip into "settling" for a life that isn't necessarily serving you at your highest levels of gratification. As with any evaluation, the goal isn't a complete or perfect snapshot and rating of every area within your life but rather a good opportunity for overall reflection. So don't stress out about the exact wording of these descriptions. Instead, do your best to give your general feeling of satisfaction for each question based on the last three months.
Personal Information:
Full Name*

First NameMiddle NameLast Name
Sex*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marriage Status*

MarriedSingleDivorcedWidowedSeparatedNever Married
Occupation*
Date of Birth*

MonthDayYear
Date
Phone Number*
E-mail*
example@example.com
Please tell me about yourself and why you are inquiring about coaching.*
Using a scale from 1 to 10 please describe your level of satisfaction in each of the items below. 1 being the lowest and 10 being the highest
COMMUNICATION - I feel my communication is grounded in honesty, compassion and respect in every relationship, whether personal or professional. *
DECISION MAKING - I am confident in my decision-making. Rarely do I worry if I have made the right decision. I do not experience angst about upcoming decisions to be made. I would describe myself as confidently decisive. *
FINANCIAL - I feel I am aligned with my financial goals. I am at peace with my vision for economic security. I am open to discussing financial goals with those close to me. I have an agreement with myself on how, when and where to prioritize my spending, to which I adhere. The word "budget" doesn't scare me. *
APPRECIATION - I feel appreciated as a human being. I actively appreciate people, places and things in my life. I am often in reverence of my surroundings and relationships. I never knew life to be so good *
FUN - Fun is natural for me. I don't feel too busy to play. It's so essential to my mental and emotional health that I will schedule my playtime if necessary. I actively participate in hobbies. I know what fun is for me. I have relationships in my life that also like to have fun and support this aspect of me.*
ACTION ORIENTED - I understand I have been my best in life after willingly taking tangible action emotionally, physically, or mentally. I refuse to get stuck in my misery; therefore, I maintain a willingness to work on myself, regardless of how overwhelming that might feel.*
VISION - I have a vision for my future that I routinely set aside time to reflect on. I understand my desires for my life, and I look forward to my future years, anticipate good things to come. I place intention into my daily activities to align with my life vision.*
HEALTH - I feel I am completely aligned with a healthy lifestyle. I feel optimistic about my health habits. I practice good balance between my enjoyments and prioritizing well-being in three critical areas of my life; psychological, emotional, and physical health.*
RELATIONSHIPS - I engage in healthy relationships. Overall, I feel I have my needs in tune with whom I choose to compliment my life. I look forward to spending time with the people within my inner circle. I have a robust group of friends. My intimate relationship is joyful more days than not. I love the decisions I have made regarding who I surround myself with.*
INTIMACY - I feel shameless about my intimate life. I am congruent in my beliefs and definition of intimacy. I effectively communicate what is essential to me and respect others' desires as well. I am estimable within my intimate lifestyle. I enjoy a satisfying intimate life. *
BOUNDARIES - As an individual, I feel good about the effectiveness and usefulness of boundaries. I know why they are essential and the necessity of honoring not only my boundaries but those of others. I can quickly identify the need for a boundary and when a limit is being communicated to me. I do not become resentful of another's boundary.*
Please provide additional insight and answer to your best capability the questions below
What significant challenges are you struggling with right now?*
What is one goal you would love to accomplish?*
If the sky was the limit, and you could do anything you wanted to do within the next thirty days, what would that be?*
What do you do for a living?*
What brings you joy in your life today?*
What negative thoughts or feelings are reoccurring for you?*
What distractions keep getting in your way of accomplishment?*
What area in your life do you feel you could use more support?*
When was a time in your life you overcame an obstacle and changed for the better as a result?*
If I was to ask you to train a class, what subject do you consider yourself an expert in?*
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INDIVIDUAL COACHING ASSESSMENT