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Client Assessment
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First Name
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Your answer
Last Name
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
I have the time to invest in myself (min. 60 minutes a week)
Yes
No
Clear selection
How willing and able are you to invest in your personal growth?
I have the financial resources to invest in my personal growth right now
I have access to the financial resources to invest in my personal growth right now
I have extremely limited financial resources to invest in my personal growth right now.
Clear selection
I am willing to give up self-sabotaging behaviors that limit my success.
Yes
No
Clear selection
Coaching is the appropriate discipline for the changes I want to make (as opposed to therapy, grief counseling for a recent loss, medical treatment, or 12-step programs)
Yes
No
Clear selection
How would you rate your overall happiness? (10 being the most happy, 1 being the least)
Least Happy
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Most Happy
Clear selection
How would you rate your level of stress? (10 being the most stressed, 1 being the least)
Least Stressed
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Most Stressed
Clear selection
How satisfied are you with your career? (10 being the most satisfied, 1 being the least)
Least Satisfied
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Most Satisfied
Clear selection
How satisfied are you with your finances? (10 being the most accurate, 1 being the least)
Least Accurate
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Most Accurate
Clear selection
How satisfied are you with your personal relationships? (10 being the most satisfied, 1 being the least)
Least Satisfied
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Most Satisfied
Clear selection
How satisfied are you with your professional relationships? (10 being the most satisfied, 1 being the least)
Least Satisfied
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Most Satisfied
Clear selection
What are the top 3 goals or objectives you'd like to work on with your coach?
Your answer
What are the biggest problems or challenges you are currently facing?
Your answer
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