Questionnaire for your
FREE COACHING STRATEGY SESSION

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

Full Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Occupation

Date of Birth

YYYY

Gender

Male

Female

Other

Marriage Status

Please briefly describe how you heard about my coaching services and why you would like a Strategy Session with me:

Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest):

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 with 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?

1. What do you do for a living, and why did you choose that career?

2. What are your top 3 goals you are striving to achieve right now?

3. What major stressors or challenges are your struggling with right now?

4. When you feel like your most successful and happy self, what makes you feel that way?

5. What would your dream life look like if you could wave a wand and make it happen?

6. What else has prevented you from having that dream life?

7. What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?

8. What 3 big changes would you like to make in your life in the next 12 months?

9. What are you most proud of and excited about in your life?

10. Why would you like to work with a high performance coach?

Source: This tool is based on proprietary concepts from High Performance Institute’s Certified High Performance Coach Program™. Do not duplicate or distribute without permission.

Questionnaire for yourFREE COACHING STRATEGY SESSION

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

Questionnaire for your
FREE COACHING STRATEGY SESSION