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Discovery Consultation Questionnaire
We are excited to learn how we can assist with creating your best life.
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1.
Your Name
(Required.)
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2.
Your Email
(Required.)
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3.
Your Phone
(Required.)
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4.
Your Age
(Required.)
18-21
22-29
30-39
40-49
50-59
60-64
65+
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5.
Your Marital Status
(Required.)
Single
Married
Partnered
Separated
Divorced
Widowed
Other
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6.
Your Occupation
(Required.)
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7.
Rate Your Physical Health
(Required.)
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
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8.
Rate Your Finances
(Required.)
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
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9.
Rate Your Career
(Required.)
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
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10.
Rate Your Relationships
(Required.)
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
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11.
Rate Your Emotions
(Required.)
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
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12.
Rate Your Time Management
(Required.)
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
NOT making progress
2
3
4
5
6
7
8
9
RIGHT where I think I should be
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13.
Pertaining to the categories of HEALTH, FINANCES, CAREER, RELATIONSHIPS, and EMOTIONS, pick 3 categories that you want to change and/or improve. In the space below, explain what would have to happen in order to take each of these 3 areas to a level 10 experience.
(Required.)
1st category change
2nd category change
3rd category change
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14.
What is the PAY OFF for achieving these goals? How is your new life going to be different? What is the upside or the reward for following through on these goals?
(Required.)
1st category rewards
2nd category rewards
3rd category rewards
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15.
What beliefs, fears and/or patterns of behaviors have prevented you from already achieving these goals?
(Required.)
1st belief or fear
2nd belief or fear
3rd belief or fear
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16.
What is the COST or the Negative Consequences for not following through? What is your life going to be life if you continue to buy into your excuses, patterns and fears?
(Required.)
1st consequences
2nd consequences
3rd consequences
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17.
Why are you a good candidate for our coaching and how do you think you will be able to benefit from a coaching program like this?
(Required.)
1st reason/benefit
2nd reason/benefit
3rd reason/benefit
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18.
What type of coaching are you looking for?
(Required.)
Performance Coaching
Accountability Coaching
Lifestyle Coaching
Relationship Coaching
Other (please specify)
Current Progress,
0 of 18 answered
