LWS Assessment

LWS Coaching Assessment

Please complete the questions below. These questions are designed to provide insight into various aspects of your life and areas where you may seek support or guidance in rebuilding and thriving.
Name

First NameLast Name
Age
Gender

MaleFemale
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status

SingleMarriedDivorcedWidowed
Occupation
Have you ever had the experience of working with a coach to navigate the challenges of parenting?

YesNo
On a scale of 1 to 5, how would you rate your current level of well-being in the aftermath of divorce, considering factors such as emotional resilience, mental health, and overall life satisfaction?
Reflecting on your parenting journey after divorce, what are some specific challenges you've encountered in maintaining a healthy and supportive relationship with your children?
How would you describe the quality of your current relationships with family members, friends, and support networks? List the areas where you feel disconnected or in need of additional support?
Considering your current commitments and responsibilities, how effectively do you feel you are managing your time, money, and energy resources? List specific areas where you would like to improve or seek guidance?
Looking ahead, what are your top priorities for rebuilding and nurturing your well-being, parenting skills, relationships, and resource management in the coming months?
Based on your responses, how soon would you like to start working on creating a better life for you and your family?*
AGREEMENT/REMINDERS:

I understand that all information I entered in this form will be considered strictly confidential.

The data gathered from this form will only be used as a basis for the type of coaching the client will need.

I understand that in order to be successful, it is vital to follow the plan agreed by both the personal growth coach and the client.
How did you find out about our services?

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What is your preferred method for us to contact you to discuss how Leaders Wellness Suite can support you?*

PhoneEmail
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LWS Coaching Assessment