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Coaching Strategy Session Questionnaire
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.
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Instructions:
Please answer the following questions to the best of your ability.
Your Full Name:
Your answer
Phone Number:
Your answer
Street Address:
Your answer
City, State, Zip:
Your answer
Country:
Your answer
Email:
Your answer
Occupation:
Your answer
Date of Birth:
MM
/
DD
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YYYY
Gender:
Female
Male
Other:
Clear selection
Marriage Status:
Married
Partnered
Single
Divorced
Widowed
Clear selection
Please briefly describe how you heard about my coaching services and why you would like a Strategy Session with me:
Your answer
Please rate yourself in the following areas of your life on a scaled of 1 (lowest) to 10 (highest).
Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?
Lowest
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10
Highest
Clear selection
Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?
Lowest
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10
Highest
Clear selection
Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?
Lowest
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10
Highest
Clear selection
Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?
Lowest
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10
Highest
Clear selection
Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?
Lowest
1
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9
10
Highest
Clear selection
1. What do you do for a living, and why did you choose that career?
Your answer
2. What are your top 3 goals you are striving to achieve right now?
Your answer
3. What major stressors or challenges are you struggling with right now?
Your answer
4. When you feel like your most successful and happy self, what makes you feel that way?
Your answer
5. What would your dream life look like if you could wave a wand and make it happen?
Your answer
6. What else has prevented you from having that dream life?
Your answer
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?
Your answer
8. What 3 big changes would you like to make in your life in the next 12 months?
Your answer
9. What are you most proud of and excited about in your life?
Your answer
10. What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident, and successful?
Your answer
11. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?
Your answer
12. What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently?
Your answer
13. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?
Your answer
14. When do you struggle to be fully present in your day or in any of your relationships?
Your answer
15. How purposeful do you feel in living each day, and how would you describe your purpose?
Your answer
16. Why would you like to work with a high performance coach?
Your answer
17. Why do you feel you could be a great student or coaching client if we worked together?
Your answer
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