Curiosity Assessment (Goddex Codes)

Curiosity Assessment

Empowered Living, LLC | Goddex Codes
Self Discovery Questionnaire

This questionnaire is designed to identify whether or not our work together would be beneficial. It will provide me with valuable information to determine if my coaching methodology aligns with your specific needs. Please fill out all areas to the best of your ability (and comfort level). Don't worry too much about it - we can always discuss anything that feels relevant during our clarity call, which I recommend we schedule for a few days from now so I can promptly review the findings here and we can discuss them together.
First things first. Tell me some of your demographic background and how you'd like me to refer to you!
Legal Name

First NameLast Name
Preferred Name (if different from above)

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
How May I Reach You At This Number?
E-mail
example@example.com
How Did You Discover My Services?

What specific areas of your life (body, spirituality, purpose, relationship) would you like to transform or improve through coaching?
Are there any specific areas of your life where you feel disempowered or out of alignment with your true potential?
How do you envision your ideal empowered self or transformed relationship? What specific changes or outcomes are you seeking?
Are there any specific goals or aspirations you have for yourself that you would like to achieve with the support of an empowerment & relationship transformation coach?

Curiosity Assessment