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High Performance Coaching Questionnaire

Questionnaire for Free Coaching Strategy Session

Goal: To help you reach heightened levels of clarity, energy, courage, productivity, and influence on your path to a successful, healthy, and fully charged life.  

Instructions:
Please answer all of the questions to the best of your ability in preparation for our first session.  Your responses will make our session more productive and help me understand what you're trying to achieve in your life. 
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Your Full Name:(Required.)
Phone Number:(Required.)
Address:
Country:(Required.)
Email:(Required.)
Occupation:
Age:
Gender:(Required.)
Marriage Status:
Please briefly describe how you heard about my coaching services.(Required.)
Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest):(Required.)
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Clarity: 
Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?
Energy:
Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?
Courage:
Do you take action and consistently express who you truly are and what you truly think, need, and desire from the world?
Productivity:
Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?
Influence:
Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?
What do you do for a living, and why did you choose that career?(Required.)
What are your top 3 goals you are striving to achieve right now?(Required.)
What major stressors or challenges are you struggling with right now?(Required.)
When you feel like your most successful and happy self, what makes you feel that way?
What would your dream life look like if you could wave a wand and make it happen?
What else has prevented you from having that dream life? 
What goal or dream have you ever given up on or failed at?  What do you believe caused you to stop or fail?
What 3 big changes would you like to make in your life in the next 12 months?(Required.)
What are you most proud of and excited about in your life?
What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident, and successful?
What eating, exercise, or general health habits would you like to begin or break in order to feel stronger and more healthy psychologically?
What distracts you the most from being more productive?  What major projects or missions are you struggling to complete faster or more efficiently?
If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?
When do you struggle to be fully present in your day or in any of your relationships?
How purposeful do you feel in living each day?  How would you describe your purpose?
Why would you like to work with a high performance coach?(Required.)