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Coaching Application
Application for coaching services - intake
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Your Full Name *
Phone Number *
Address
City, State, Zip
Country
Your Best Email *
Job Title
Date of Birth
MM
/
DD
/
YYYY
Please briefly describe you hear 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? *
no
yes
ENERGY: Do you consistently have enough mental and physical energy to excel, accomplish your goals, and feel motivated and happy? *
no
yes
COURAGE: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?   *
no
yes
PRODUCTIVITY: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?   *
no
yes
INFLUENCE: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?   *
no
yes
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 you 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? *
High Performance Questions:
1. What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful? *
2. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically? *
3. What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently? *
4. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving? *
5. When do you struggle to be fully present in your day or in any of your relationships? *
6. How purposeful do you feel in living each day, and how would you describe your purpose? *
7. Why would you like to work with a high performance coach? *
8. Why do you feel you could be a great student or coaching client if we worked together? *
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