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1:1 Coaching Sessions with Lucia - Initial Questionnaire
Please fill out this questionnaire so we can make your journey with Lucia as transformational and impactful as possible.
All information entered is strictly confidential and will never be shared.
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* Indicates required question
Email
*
Your email
What is your first name and last name?
*
Your answer
What is your time zone?
*
Your answer
What is your age?
25-34
35-44
45-54
55-65
66-75
Other:
Clear selection
What is your marital status?
*
Single
In a relationship
Married
Separated
Divorced
Widowed
Other:
Are you currently employed?
*
Yes
No
If employed, what is your role in the company you work for?
*
Your answer
What is your total annual income?
Your answer
What is your biggest challenge today?
*
Your answer
What is your experience in coaching, if any?
*
Your answer
How many hours a month do you dedicate to wellness and leadership training?
Your answer
How well do you correlate your happiness to the results in your life and work?
*
None
1
2
3
4
5
6
7
8
9
10
100% correlated
Are you living in your purpose?
*
No
1
2
3
4
5
6
7
8
9
10
Absolutely
How much do you love yourself?
*
Not at all
1
2
3
4
5
6
7
8
9
10
I love myself fully
How happy are you right now?
*
Not at all
1
2
3
4
5
6
7
8
9
10
Thriving!
What is your level of emotional awareness? In essence, are you able to control your emotions (proactive), or are your emotions controlling you (reactive)?
*
I don't know how to control how I feel
1
2
3
4
5
6
7
8
9
10
I am a master at understanding and controlling my emotions
Are you able to manage your own time or is time managing you?
*
I can't control time
1
2
3
4
5
6
7
8
9
10
I create my own experience
What is your relationship with money?
*
I am totally misaligned with my finances
1
2
3
4
5
6
7
8
9
10
Thriving and looking for growth
What is your relationship with work?
*
I feel unfulfilled with my business/job
1
2
3
4
5
6
7
8
9
10
I am in my purpose and love and thrive in what I do
What is your relationship to your body?
*
I don't take care of my physical health
1
2
3
4
5
6
7
8
9
10
I invest in wellness and look after myself every week
What is your relationship with food?
*
I don't pay attention to my nutrition
1
2
3
4
5
6
7
8
9
10
I pay attention and take great care of the foods I ingest
What is your relationship with your family?
*
None
1
2
3
4
5
6
7
8
9
10
Love
What is your relationship with your romantic partnerships?
*
I struggle
1
2
3
4
5
6
7
8
9
10
I am aligned and love the person I get to share my journey with
How aligned are you with the goals and results you want to achieve in life today?
*
I don't know what I want
1
2
3
4
5
6
7
8
9
10
I am already thriving and want to experience the next level
What have been your 3 greatest successes to date?
*
Your answer
What is most important to you in your life and why?
*
Your answer
What are the top 3 challenges you are facing right now?
*
Your answer
Are you willing to see your challenges through to the end?
*
Yes
No
What would be your #1 goal today for engaging in coaching sessions with Lucia?
*
Your answer
Are you willing to invest in yourself and experience transformation in your life?
*
Yes
No
Are you willing to commit to an appropriate amount of time to learning and growing your areas of life?
*
Yes
No
Did someone refer you to Lucia?
Yes
No
Clear selection
If yes, who?
Your answer
Would you like to share anything else with Lucia?
Your answer
A copy of your responses will be emailed to the address you provided.
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