Please fill out this questionnaire before scheduling your first session. You will receive an email with your completed survey for your own records.
Click the button below to start.
Just some basic info to get us started. :)
Question 2 of 44
Full Name
Question 3 of 44
Preferred Email Address
Question 4 of 44
Best Phone Number to reach you?
Question 5 of 44
What is your mailing address (so we can send you something nice!)?
Question 6 of 44
What is your date of birth (MONTH/DAY)?
For the following areas of life, please rate your current level of satisfaction (10 = completely satisfied, 0 = completely unsatisfied)
Question 8 of 44
Hobbies / Leisure / Play
10
9
8
7
6
5
4
3
2
1
0
I'd rather not say
Question 9 of 44
Career (being a sought after expert or resource)
Question 10 of 44
Job (the work you do with your mind and body on a daily basis)
Question 11 of 44
Income (the monthly or annual income you generate)
Question 12 of 44
Wealth (building long term wealth and financial stability)
Question 13 of 44
Legacy (contributing to humanity or your community)
Question 14 of 44
Sex
New Choice
Question 15 of 44
Intimacy & Romance
Question 16 of 44
Relationship with significant other / desire to have a relationship
Question 17 of 44
Parenthood / Desire to become a parent
Question 18 of 44
Relationship with mother
Question 19 of 44
Relationship with father
Question 20 of 44
Relationship with siblings
N/A
Question 21 of 44
Relationship with close friends
Question 22 of 44
Health and Well Being
Question 23 of 44
Physical Fitness
Question 24 of 44
Peace of Mind
Question 25 of 44
Spirituality and Faith
Question 26 of 44
Please enter any ratings for areas of life not covered (optional). If none, type "None."
In this section please provide information about your goals and objectives.
Question 28 of 44
Please describe your medium term (1 - 3 year) goals for your life and your business/career.
Question 29 of 44
What concerns, obstacles, or challenges do you think you will face in achieving your medium term goals?
Question 30 of 44
If you could accomplish ONE specific result from our coaching, what would it be and why? (Please be as specific as possible)
The following questions help me understand your current business or employment.
Question 32 of 44
Which statement best applies to your work and business situation?
I work full-time for a company but I want to start my own business.
I work part-time in my own business but I also have a full-time job.
I operate a "soloprenuer" business which employs myself.
I own and operate a small business with 3 to 100 employees
I am a business partner/investor in a business with more than 100 employees.
I'm currently in transition in my work and income.
Question 33 of 44
What is your approximate annual business revenue (before taxes)?
$1,000 to $12,000 per year.
$12,001 to $24,000 per year
$24,001 to $48,000 per year
$48,001 to $96,000 per year
$96,001 to $252,000 per year
$252,001 to $750,000 per year
$750,001 to $1.5 million per year
$1.5 million to $3.0 million per year
$3 million dollars per year or more
I don't know
Question 34 of 44
Please describe your product or services. What type of customers do you serve? Why do they hire you?
Question 35 of 44
How do you generate new business opportunities or clients? What are your current "lead sources?"
Question 36 of 44
Which of the following technology systems do you use in your business? (Select all that apply)
Email Marketing System (e.g. Mailchimp, ConstantContact, etc.)
Customer Relationship Management (CRM) System (e.g. Salesforce, Zoho)
Accounting System (e.g. Quickbooks, Quicken)
Website Platform (Squarespace, Wordpress, etc.)
Industry specific software
Question 37 of 44
Please provide any other details about your business you think I should know.
In the next section, please answer the questions related to inner awareness and coaching styles.
Question 39 of 44
What is one thing you do not like doing that you know is good for you, your business, or your relationships?
Question 40 of 44
What is something you love doing that you wish you could do more of?
Question 41 of 44
When you get confronted or scared, how do you get people to "back off"? What would people see you doing or not doing in response to confrontation or fear?
Question 42 of 44
What are your "trigger topics"? What are your hot button issues? What do you find yourself getting most upset about?
Question 43 of 44
Have you ever hired a business or life coach before?
Yes
No
Question 44 of 44
Are you willing to be coachable? Coachable requires giving up your point of view or beliefs.
I'm not sure.