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* 1. What is your full name?

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* 2. What is your current mailing address?

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* 3. What is your preferred telephone number?

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* 4. At what email address would you like to be contacted?

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* 5. Which of the following categories best describes your employment status?

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* 6. What are the 3 biggest changes you want to make in your life in the next 3 months?

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* 7. What are the 3 biggest changes you want to make in your life over the next 3 years?

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* 8. What do you most want to achieve during our initial coaching period? What most threatens to hold you back from achieving this goal?

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* 9. What have been your 3 most fulfilling accomplishments in life so far?

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* 10. How have you failed, and how has that affected the way you think and act today?

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* 11. How have your attitudes about people and life changed over the past 5 years?

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* 12. What should I know about your professional background or history?

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* 13. What should I know about your personal background or family history?

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* 14. Do you have any mental health challenges (e.g. depression, bipolar disorder, anxiety, etc) that have affected you? If so, please tell me about that.

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