Certified High Performance Coaching

Goal: To help you reach heightened levels of clarity, energy, courage, productivity, and influence on your march to a successful, healthy, and fully charged life.

Instructions: Please answer the questions below and on
the following pages to the best of your ability before our call.
Your Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Occupation
Your Date of Birth

MonthDayYear
Date
Gender

FemaleMale
Marriage Status

SingleMarriedDivorced
Please briefly describe how you heard about my coaching services and why you would like a Strategy Session with me:

1. What do you do for a living, and why did you choose that career?
2. What are your top 3 goals you are striving to achieve right now?
3. What major stressors or challenges are you struggling with right now?
4. When you feel like your most successful and happy self, what makes you feel that way?
5. What would your dream life look like if you could wave a wand and make it happen?
6. What else has prevented you from having that dream life?
7. What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?
8. What 3 big changes would you like to make in your life in the next 12 months?
9. What are you most proud of and excited about in your life?

High Performance Questions:
1. What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?
2. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?
3. What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently?
4. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?
5. When do you struggle to be fully present in your day or in any of your relationships?
6. How purposeful do you feel in living each day, and how would you describe your purpose?
7. Why would you like to work with a high performance coach?
8. Why do you feel you could be a great student or coaching client if we worked together?
I consent to having Sherry Richert Belul collect and store my information via this form.*

Yes, I consent
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