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1. Do you currently have a coach or have you previously worked with a coach? Yes No 2. Are you looking for a coach? Yes No 3. If you and I were to work together, what are the top 3 things you would want to accomplish in the first 30-90 days? 4. What's currently in the way such that you do not have these results in your life already? 5. If you were to produce these results, what monthly investment would that be worth to you? Under $300 $300-500 Over $500 6. What are three areas of your life that you are committed to improving? 7. What is something you believe you cannot have, or cannot do in your lifetime? 8. Why? 9. On a scale of 1-10, with 10 being completely balanced, how would you rate your level of life balance currently? 1 2 3 4 5 6 7 8 9 10 10. What would have to happen for this to be raised by 1 to 2 points? 11. If you were to FULLY live your life, what is the first change you would start to make? Please select the number that comes closest to representing how true the statement is for your right now in your life, with 1 being the least true and 5 being completely true. 1 2 3 4 5 I keep my word and can be relied upon to be on time for all calls. 1 2 3 4 5 I will be honest and forthright, speaking what's true to my coach. 1 2 3 4 5 I am willing to modify the self-defeating beliefs which limit my success. 1 2 3 4 5 I am willing to 'try on' new concepts or way of doing things. 1 2 3 4 5 I have adequate funds to pay for coaching and see it as an investment.
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