Coaching Discovery
Bette Haskin, Certified Life and Business Coach
Full Name
Email
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Phone Number
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Date of Birth
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Month
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Day
Year
Full Address
How did you hear about me?
If you were referred, name of the person who referred you.
Preferred Method of Contact
Text
Call
Awaken
Discover where you are and where you want to go!
Describe where you are right now with your limitations...
Describe where you want to be in 6 months / 1 year...
Please describe WHY you are interested in transforming. (What is your main Motivation... relationships, activities, lifestyle, how you feel, etc.)
When was the last time you remember feeling confident and strong, feeling happy with your current state, your vision, and your future goals?
Sleep
How many hours of sleep do you typically get?
What time do you typically go to bed?
What time do you typically wake up?
How is the quality of your sleep?
Do you wake up feeling rested?
Motion
On a scale of 1-10, what is your energy level throughout the day?
How many days a week do you exercise?
About how many hours a day do you sit or lay down?
What types of physical activity do you enjoy?
How would you describe the quantity and quality of the activity you do each week?
Stress
On a scale from 1-10, how much do you worry?
What do you do for work?
On a scale from 1-10, how much do you enjoy what you do?
On a scale from 1-10, how fulfilled are you?
What area of your life tends to be the biggest stress for you?
Eating Habits
How many meals per day do you eat?
When do you eat your first meal?
When do you eat your last meal?
Do you snack between meals?
How much do you eat out each week?
Where do you eat out?
Hydration
How much water do you drink per day?
How much Coffee?
How much Soda?
How much Tea?
How much Alcohol?
Weight
Current weight
Height
Surroundings
On a scale from 1-10, how successful/healthy would you rate your surroundings?
Do you have proactive & engaged friendships, supportive family, etc.?
Do you have any partners, friends, or coworkers that you need or want support from?
Is there anything else you think I should know about you?
What's holding you back? Don't think too hard, just go with your gut; What's your biggest obstacle?
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