Breakthrough Coaching Questionnaire

Platinum Success Strategy Session Questionnaire

Master your mindset, and master your life.
Congratulations on considering coaching to move you from where you are to where you want to be. As your coach, we partner in a thought-provoking and creative process to inspire you to maximize your personal and professional potential! The answers you provide on this form helps me know a little about you and your journey so far, and -- along with our 30 minute discovery session -- will help us determine if we are a good fit for each other, which any partnership must be.

So give some thought to the questions below and answer to the best of your ability. Allow yourself the space to reflect before answering.

If you can’t answer any of the questions, I invite you to leave them to the end and before you hit submit, have another look over and see if anything new comes up.

As you will learn with coaching, there is no right or wrong answer!

If you have any questions, please reach out via email, phone or facebook.

Let’s get started!!
Date

MonthDayYear
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number
Skype Name
Best time of day (usually) to schedule a call.
Occupation
Marital Status
Tell me a little about yourself.
What influenced your desire to work with a coach?
What are your desired outcomes from coaching?
When it comes to mindset, and personal goals, what are your biggest challenges?
On a scale of 1 to 10 (10 being highest), how important is it to overcome these challenges.
What is your number one obstacle, that's kept you from solving these challenges?
What would you like your life to look like in 6 months... then 12 months?
What do you believe prevents you from having the life you want, now?
What is the MOST IMPORTANT single thing you would like accomplish or gain as a result of coaching?
Is there anything else you want me to know?
Thank you for taking the time to tell me a little about you. As soon as I review your information, I will send you a link to choose an appointment date and time that is convenient for you.

Looking forward to our conversation. Have an awesome day!

Kelvin P. Ringold, Sr.
Prince of Positive
Chief Empowerment Officer
Certified Life Coach
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Platinum Success Strategy Session Questionnaire