Name
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First Name
Last Name
Email Address
*
Phone number
(###)
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
Date of Birth
MM
DD
YYYY
Gender
Male
Female
Marital Status
Single
Married
Divorced
Separated
Other
Briefly describe how you heard about my coaching services and why you would like a discovery session with me?
CLARITY: I clearly know my purpose.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
HEALTH/ENERGY: I consistently feel energized mentally and physically to approach my day with the happiness and motivation to look, feel, and do my best.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
CONFIDENCE: I am confident enough to be my most authentic self - using my voice to communicate and bring who I am into the world.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
MINDSET: I am able to manage my thoughts, and consistently put my in a positive frame of mind and live with an empowered outlook.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
CONSISTENCY: I feel that I am taking action daily to achieve my goals, and consistently moving forward towards them.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
CONTROL: I feel 100% in capable and in control of my life and the things that happen to me.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
What fears or behaviours would you like to overcome in order to feel more free, confident and successful?
What negative recurring thoughts do you experience? When do you find yourself thinking them most often?
What eating, exercise or general health habits would you like to begin or break in order to feel your healthiest and happiest?
If you were living with more confidence and courage, what would that look like? What would you be doing?
What excited you about working together? Why do you feel you would be a great student or client if we worked together?
What one thing, if achieved, would make the biggest impact over the next 3 months?
What do you do for a living and why did you choose your career?
If you are not in your dream career, what is your dream career?
What top 3 goals are you striving to achieve right now?
What major stressors or challenges are you facing right now?
When you feel happiest? What makes you feel that way?
If you could wave a wand and live your dream life, what would that look like? Please explain it to me.
What has prevented you, or prevents you from living your dream life?
What 3 big changes would you like to make in your life over the next year?
What are you most excited about in your life right now?