Name
First Name
Last Name
Email
*
Phone
(###)
###
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What are the 3 areas where you feel challenged?
Things like confidence, establishing healthy routines, self-esteem, self-care.
Have you worked with a life coach before? If yes, what were the results?
Are you 'coachable'? Meaning, are you attached to the story or are you ready to take responsibility for your future?
Who are some of the teachers and guides you listen to?
What are the changes you'd like to make in the next 12 months?
What is currently going well in your life?
What are your top 5 values?
Measuring from where you are right now, what percentage away from your 'best self' are you?
Example right now I'm at 10% so I'm 90% away from my best self.
Do you have a support system? Family/friends/associates?
What are past challenges you've overcome?
What are you most proud of in your life so far?
On a 1 (low) to 5 (high) scale, rate your self-awareness, empathy, autonomy, confidence.
On a 1 (low) to 5 (high) scale, rate your: Physical, mental, emotional, spiritual wellness.
What supportive and nurturing things are you doing for your physical, mental, emotional, spiritual wellness?
What is your understanding of your soul, soul wounds, soul healing?
What are the most important things to change for you to feel like you're making progress?
How willing are you to try new things/methods/ways of doing things?
How motivated are you to make positive changes in your life? Are you committed to being an active participant and do the work in between coaching calls?
Do you understand that if selected, you will sign a consent form for the audio recording of the sessions to be published?
Anything else you'd like to share?
Your city / country
