Box of Rain Coaching Questionnaire
Thank you for your interest in life coaching with me. Your answers on this form will help me tailor my services towards your unique journey. Please know that the more honest you are in your answers, the more I can get to the root of your concerns. Also know that I hold space for you exactly as you are and will never judge you based on what you share, and all personal information will be kept confidential. We are all together on this journey called life.
Your Contact information
Please enter your contact information below so I can get in touch with you.
Full Name
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Preferred Name (What would you like to be called?)
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What did your mom call you when she was mad at you?
Email Address
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Email Validator
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Cell Phone Number
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Your Goals
Personal Short-Term Goals
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Personal Long-Term Goals
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Work/Business Short-Term Goals
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Work/Business Long-Term Goals
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Are there current work-life balance issues you want to work on?
How do you feel about your work/life balance?
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How do you see yourself relating your work life to your personal life?
Client needs you
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Vacation time with family
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Scheduled recurring business meeting
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Healthy diet
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Working long hours have to get work done
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Scheduled personal/self-care time daily
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Kids need homework help
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Project has to get out
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Me time
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Least Important
1
2
3
4
Most Important
5
1 is Least Important, 5 is Most Important
Work Life Balance
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No Balance, work interferes
1
2
3
4
I have a good work-life balance
5
1 is No Balance, work interferes, 5 is I have a good work-life balance
What do you want to work on with me?
What are the 5 things you would like to work on as broad strokes?
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What are the 2 definitive things you want to work on to start?
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They will change over time.
Is the meeting end time a hard and fast cutoff, or do you have flexibility?
Hard Stop
Flexible
What are you hoping to achieve through a coaching program?
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Commitment and Availability
Tell me about your average day.
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What is prompting you to do something about this now?
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How would your life improve if the issue was solved?
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What does solving this problem mean to you personally?
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What will happen if there is no change?
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Hell will freeze over, and the demons will eat ice cream.
What have you tried so far? What has helped and what has failed?
How would you spend your time if you weren't spending it trying to improve yourself?
Are you ready to make yourself a priority? What does making yourself a priority look like to you?
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(Optional) Do you have any conditions or situations that I might need to know about?
Is there anything else that you want me to know?
What does making yourself a priority look like to you?
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What does your existing diet and workout routine look like?
Anything else that you want to let me know about that can interfere with growth?
Are you ready to make yourself a priority?
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Hell Yes!!!
Yes
Maybe
I will think about it
No
Submit
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