Individual Coaching Preliminary Questionnaire * 1. Personal Info Name Email Address Phone Number * 2. Rank in order with 1 being the most important: 1 2 3 4 5 6 Family/Partner 1 2 3 4 5 6 Business 1 2 3 4 5 6 Health 1 2 3 4 5 6 Personal Growth/Self Knowledge 1 2 3 4 5 6 Spiritual Growth 1 2 3 4 5 6 Adventure/Travel * 3. What is your biggest daily obstacle/challenge? * 4. What does amazing success look like for you in the next year? * 5. How do you spend your time daily? Describe a "typical day" for you. What you do from when you get up in the morning until when you go to bed at night. * 6. Why do you believe working with a coach will help you at this point in your life? * 7. What would you like to accomplish with me after 6 - 12 months? * 8. Rate your current level of overall happiness. (Ten is the highest level of happiness.) 1 2 3 4 5 6 7 8 9 10 * 9. Rate your desire/commitment to change. (Ten is the highest level of commitment) 1 2 3 4 5 6 7 8 9 10 Done