Coaching Questionnaire
Thank you in advance for filling out this questionnaire
Your Full Name
Email
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What are current areas of life that you feel need improved? (relationship, happiness, feeling of being stuck etc..)
Family, career, parenting, addiction, depression, anxiety..
How often to you find yourself wishing things were different?
Please Select
Multiple times Daily
Several times a week
On the weekends
When something bad happens
occassionally
Never
Pick one that BEST describes your situation
What areas of life do you value the most?
Health, career, mission-purpose, family, life Style, spirituality
How would you rate your over all life right now?
Please Select
Very unhappy
Somewhat unhappy
I am ok
Sort of Happy
Very happy
What do you think would help your life change in the direction you want it to go?
Write a paragraph
When are need help with a life issue, where do you go most often? choose all the apply
Reading
Podcast
TV
Pastor / religious sources
Spouse / intimate relationship
Trusted friend
Boss supervisor or co worker
Parents / family member
Therapist / Counselor
Life Coach / Professional helper
What successes have you had in life? What have you done well in the past?
Be brief but give several examples of how good you are...
Why do people go see a therapist / counselor? (Generally are licensed by the state)
Describe why you think others seek help
Why do people see a life coach rather than a therapist / counselor? (life coaches are not licensed by any state)
Describe why you think others seek different help
Have you ever seen a therapist / counseling in the past?
Yes
No
Any other special comments
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