Questionnaire Application For Free Strategy Session
Instructions:
Please answer ALL of the questions to the best of your ability. These questions help me get to know your goals and understand how you are performing in the six pillars of high performance: psychology, physiology, productivity, persuasion, presence, and purpose. Once submitted, I will review and let you know if you qualify for the Strategy Session. Please allow a few days for the review.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Date of Birth
*
Please briefly describe how you heard about my coaching services and why you are applying for a Strategy Session
*
Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest):
Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?
*
Not At All
1
2
3
4
5
6
7
8
9
Very Clear
10
1 is Not At All, 10 is Very Clear
Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivate and happy?
*
No Energy
1
2
3
4
5
6
7
8
9
All the Energy in the World
10
1 is No Energy, 10 is All the Energy in the World
Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?
*
Never
1
2
3
4
5
6
7
8
9
Always
10
1 is Never, 10 is Always
Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?
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Never
1
2
3
4
5
6
7
8
9
Always
10
1 is Never, 10 is Always
Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?
*
Not at All
1
2
3
4
5
6
7
8
9
Absolutely 100%
10
1 is Not at All, 10 is Absolutely 100%
What do you do for a living, and why did you choose that?
*
What are the top 3 goals you are striving to achieve right now?
*
What major stressors or challenges are you struggling with right now?
*
When you feel like your most successful and happy self, what makes you feel that way?
*
What would your dream life look like if you could wave a magic wand and make it happen?
*
What else has prevented you from having that dream life?
*
What goal or dream have you ever given up on or failed at?
*
What 3 big changes would you like to make in your life in the next 12 months?
*
What are you most proud of and excited about in your life?
*
Why would you like to work with me as your coach?
*
Submit
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