Clone of Do It Differentley Coaching

Kimberly Trefz - Coach, Meditator, Spellbreaker, Brain Trainer

Small changes really do add up! By showing up for yourself every day,
you are setting yourself up to create something amazing!

Full Name*

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E-mail*

Phone Number*

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On a scale from 1 - 10, how SATISFIED are you with your life overall?*

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

Why that Satisfaction rating?*

On a scale from 1 - 10, how much FUN are you having in your daily life?*

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

Why that Fun rating?*

On a scale from 1 - 10, how is your RELATIONSHIP with your significant other, family, friends?*

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

Why that Relationship rating?

On a scale from 1 - 10, how is your overall HEALTH + FITNESS?*

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

Why that Health or Fitness rating?*

On a scale from 1 - 10, how is your overall CAREER + BUSINESS + FINANCIAL path?*

	1	2	3	4	5

1 is Worst, 5 is Best

Why that Career + Business + Financial path rating?*

What major STRESSORS or CHALLENGES are your struggling with right now?*

What EXCITES you? Rate each item in terms of what INSPIRES You.*

What would your DREAM LIFE look like if you could wave a wand and make it happen?*

What are you most PROUD of and EXCITED about in your life?*

Have You worked with a coach or been part of a mastermind?*

YesNo