Name
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First Name
Last Name
Email
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Phone
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Age
Birthplace
Current City/ Time Zone
Current Occupation
Level of satisfaction with your work:
Dream Occupation
Personal Goal #1: This can include problems would you like to address, areas of your life that you would like to improve, and/or your short-term/long-term goals.
Personal Goal #2: This can include problems would you like to address, areas of your life that you would like to improve, and/or your short-term/long-term goals.
Personal Goal #3: This can include problems would you like to address, areas of your life that you would like to improve, and/or your short-term/long-term goals.
Do you consider yourself a perfectionist? If yes, please explain:
Describe your ability to concentrate and focus:
How do you manage emotions, anxiety, and stress?
Please describe any meditation or mindfulness practices (if any):
Do you struggle with feeling sadness, loneliness and/or depression?
Describe your overall life satisfaction:
Describe your overall physical health or any current medical issues:
Describe your sleep (average quality and amount of sleep/night):
If could change one thing about your life, what would it be?
Have you worked with a coach or therapist in the past? If yes, please elaborate:
Describe why you would like to work with a coach:
How committed are you to change? What is your main motivation?
Are you willing to do additional homework and exercises between coaching sessions? How much time are you willing to commit per week?
Is there anything else you would like to share with me?