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Client Coaching Survey
10
Questions
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1
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If there was ONE BIG CHANGE that you wanted to make in your life, what would it be? What is the biggest challenge, frustration or problem that's getting in your way of making that change? (please be as specific as possible)
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2
Name
First Name
Last Name
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3
Email
example@example.com
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4
Phone Number
Please enter a valid phone number.
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5
Answer the following questions on a scale from 1-10
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1 = Not at all true 10 = Absolute truth
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Stress - I feel that I am in complete harmony with my stress levels. There isn't much that knocks me off balance
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Anxiety - I don't have any issues with anxiety. I always feel completely calm, relaxed and at ease.
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Stress - I feel that I am in complete harmony with my stress levels. There isn't much that knocks me off balance
Anxiety - I don't have any issues with anxiety. I always feel completely calm, relaxed and at ease.
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6
Answer the following questions on a scale from 1-10
*
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1 = Not at all true 10 = Absolute truth
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Clarity - I feel that I am clear about who I am, my purpose, and the direction I want to go in life
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Biology - I have enough mental and physical energy needed to accomplish everything I set out to accomplish on a consistent basis
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Clarity - I feel that I am clear about who I am, my purpose, and the direction I want to go in life
Biology - I have enough mental and physical energy needed to accomplish everything I set out to accomplish on a consistent basis
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7
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What major stressors or challenges are getting in your way right now?
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8
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How much would you be willing to invest for you to optimize your life in all of the above categories?
$500-$1000
$1000-$5000
Other
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9
Type a question
How much time would you be willing to commit for a coaching program to take you where you are now to where you want to go?
2-4 weeks
4-6 weeks
6-8 weeks
However long it takes..
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10
Type a question
Is there anyone else involved in you making this decision (If so, I recommend having a conversation prior to us having a meeting)
No, just me
Yes, but I will have a conversation prior to our meeting
Other
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