High Performance Coaching - Intro Session Questionnaire    
Goal: To help you reach heightened levels of clarity, energy, courage, productivity, and become your most successful, healthy, and fully charged. Find the "more" within you. Achieve your dreams!

Instructions:
Step 1: Fill out this questionnaire if you would like to set up a strategy call. Please answer the questions below to the best of your ability.

Step 2: If you’re a great fit, we will schedule your strategy session. It's that easy and I'm looking forward to working with you! 

Strategy session is $50 and will be applied to your first six one-one sessions or group coaching. If after our strategy session, you feel that our time together was not beneficial, please ask for a full refund. There is no obligation to continue beyond the strategy session.


Source: This tool is based on proprietary concepts from High Performance Institute's Certified High Performance Coaching ProgramTM.
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Email *
Name *
Phone Number *
Occupation/Business or Major Study? *
Years in Occupation/Business or Grade in School?
Date of Birth (month/day/year or age)
Please briefly describe how you heard about my coaching services and why you are interested in pursuing coaching with me: *
Interested in: *
Please rate yourself in the following areas of your life on scale 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? *
Very Unclear
Extremely Clear
Energy: Do you consistently have the mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? *
Lacking Required Energy
Abundant High Energy
Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? *
Not Super Courageous
Courage To Take On Anything
Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? *
Unproductive/Lack Focus
Super Productive/Laser Focus
Influence: Do you feel you have the social support of your family, friends, and team needed to accomplish your goals? *
Not Influential
Highly Influential
What is your favorite thing about your work/business or school life?  *
What are you currently working on or studying? *
What are your top three goals you are striving to achieve right now? *
What stress or challenges are you dealing with right now? *
When you feel most successful and happy what makes you feel that way? *
What would your dream life look like if you could wave a wand and make it happen? *
What is preventing you now or has prevented you in the past from having that dream life? *
What dream or goal have you ever given up on or failed at, and what do you believe caused you to stop or fail? *
What 3 big changes would you like to make in your life in the next 12 months? *
What are you most proud and excited about in your life? *
What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?  *
What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically? *
What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently? *
If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving? *
When do you struggle to be fully present in your day or in any of your relationships? *
How purposeful do you feel in living each day and how would you describe your purpose? *
Why would you like to work with a high performance coach? *
Why do you feel you could be a great student or coaching client if we worked together? *
Please use this space for any questions or comments you may have.
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