Preliminary Questionnaire

Hello Lovely!
Thank you for your interest in working with me as your coach & mentor as you desire to fulfill your life & love goals. By answering each question honestly and thoroughly, together, we can maximize the our time together and develop clear goals and a plan for your personal and relationship success!  I will personally and confidentially review your submission.
Thank you in advance for taking time to complete the questionnaire. I am looking forward to speaking with you soon.
-Teresa Renee

* 1. Address

* 2. I am...

* 3. I am...

* 4. I have been in my current relationship/marriage for...

* 5. Evaluate the following statements.

  Strongly Disagree Disagree Agree Strongly Agree
I am satisfied with my life and my love relationships
I enjoy my life more when I am in a relationship.
I know what I need in a mate
I know what I can offer, and the value I bring to a relationship
I know what it takes to have a healthy relationship
I am ready to face the truth about myself
I want to change some things in my life and/or relationship but I don't know where to start
I am ready for action and accountability

* 6. (6.A.) What are your personal strengths?
(6.B.) What is your greatest strength(s) or asset you can offer in a relationship?

* 7. What problems or challenges are you facing in regard to your life, love, your relationship, and/or with yourself?

* 8. Why are you interested in coaching/mentoring?  What do you need help with and/or what are your seeking?

* 9. What are your top 3 personal or relationship goals?

* 10. What are you hoping to gain from working with Teresa as your coach & mentor?