check

Discovery Call Questionnaire

Please take some time for yourself and answer the following questions to the best of your ability. Once I receive your answers I will be in touch to confirm a mutually convenient time for our call.

Ready, let's go!

Start

Question 1 of 27

Name

Question 2 of 27

Email

Question 3 of 27

Phone

Question 4 of 27

Address 

Question 5 of 27

Relationship Status 

A

Married

B

Single

C

Committed Relationship

D

Divorced / Separated

Question 6 of 27

Date of Birth

Question 7 of 27

Please describe briefly how you heard about my coaching services and why you would like a discovery call with me:

Question 8 of 27

CLARITY - DO YOU FEEL CLEAR ABOUT WHO YOU ARE, YOUR PURPOSE AND THE DIRECTION YOU WANT TO GO IN YOUR LIFE? 


Please rate yourself in the following area of your life on a scale of 1 (lowest) to 10 (highest) 

 

 

Question 9 of 27

ENERGY - DO YOU CONSISTENTLY HAVE THE MENTAL AND PHYSICAL ENERGY NEEDED TO EXCEL, ACCOMPLISH YOUR GOALS AND FEEL MOTIVATED AND HAPPY?


Please rate yourself in the following area of your life on a scale of 1 (lowest) to 10 (highest)

Question 10 of 27

COURAGE - DO YOU TAKE ACTION AND CONSISTENTLY EXPRESS WHO YOU TRULY ARE AND WHAT YOU TRULY THINK, NEED AND DESIRE IN THE WORLD? 


Please rate yourself in the following area of your life on a scale of 1 (lowest) to 10 (highest)

Question 11 of 27

PRODUCTIVITY - ARE YOU CONSISTENTLY FOCUSSED AND EFFECTIVE, AND ARE YOU GOOD AT MINIMIZING DISTRACTIONS AND MAINTAINING PRIORITIES? 


Please rate yourself in the following area of your life on a scale of 1 (lowest) to 10 (highest)

Question 12 of 27

INFLUENCE - DO YOU FEEL YOU HAVE THE SOCIAL INFLUENCE WITH YOUR FAMILY, FRIENDS, AND TEAM NEEDED TO ACCOMPLISH YOUR GOALS? 


Please rate yourself in the following area of your life on a scale of 1 (lowest) to 10 (highest)

Question 13 of 27

What do you do for a living and why did you choose that career? 

Question 14 of 27

What are your top 3 goals you are striving to achieve right now?

Question 15 of 27

What major stressors or challenges are you struggling with right now?

Question 16 of 27

When you feel like your most successful and happy self, what makes you feel that way?

Question 17 of 27

What would your dream life look like if you could wave a magic wand and make it happen? 

Question 18 of 27

What has prevented you from having that dream life?

Question 19 of 27

What goal or dream have you ever given up on or failed at, and what do you believe caused you to fail or stop?

Question 20 of 27

What 3 big changes would you like to make in your life in the next 12 months?

Question 21 of 27

What are you most proud of and excited about in your life?

Question 22 of 27

What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?

Question 23 of 27

What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physically? 

Question 24 of 27

What distracts you the most from being more productive, and what major projects are you struggling to complete as a result?

Question 25 of 27

If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

Question 26 of 27

When do you struggle to be fully present in your day or in any of your relationships?

Question 27 of 27

How purposeful do you feel in living each day, and how would you describe your purpose?

Confirm and Submit