Your Name (required)
Date of Birth (required)
Do You Have Children?
Best Days & Hours For Life Coaching:
Are you seeking coaching to change something in your Personal or Professional Life?
What, specifically, has prompted you to inquire about coaching at this time?
Are you coachable?
Are you willing to do the work and let the coach do the coaching?
What do you hope to accomplish through coaching?
Are you willing to give the coach the benefit of the doubt and “try on” new concepts or different ways of doing things?
If you feel you are not getting what you need or want from the sessions, are you willing to indicate this to the coach at the earliest possible opportunity – and ask for what you do want?
Do you see being coached as a worthwhile investment in your future?
Are you willing to look at and modify any self-defeating behaviors that are limiting your success?
Will you tell the truth to your coach at all times, even if it is painful?
Are you currently in any sort of therapy?
Can you be relied on to be on time for sessions?
On a scale of 1 to 5, with 1 being very little and 5 being very much, how much are you committed to working toward accomplishing your desired goal(s) through coaching?