YES to Your Best Self Coaching Questionnaire

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To better serve you, please take time to complete this short answer survey and return to me. I sincerely appreciate your input, feedback, and inspiration.

Name: *

Phone Number: *

Address: *

Country and Time Zone: *

Occupation: *

Date of Birth *

YYYY

Gender: *

Female

Male

Prefer not to say

Other:

Marital Status *

Briefly explain how you heard about this group coaching program and what you would like to accomplish during this time. *

Please read the following questions and circle the number that most closely corresponds to how you feel right now with 1 being Lowest and 10 being highest

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? *

Mental Energy: Do you consistently have enough mental energy needed to excel, accomplish your goals, and feel motivated and happy? *

Physical Energy: Do you consistently have enough physical energy needed to excel, accomplish your goals, and feel motivated and happy? *

Courage: Do you take action and consistently express yourself genuinely and authentically – feeling able to express what you think, need, and desire to 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 influence with your family, friends, and team needed to accomplish your goals? *

Please answer the following questions briefly, but completely.

What do you do for a living? Why did you choose that career? (Note – if you are a stay at home parent that is a career! Why did you choose that?) *

Goals: What are the top 3 things you are trying to achieve right now? *

What are the major stressors in your life right now that impact your goals, lifestyle or feelings of wellbeing? *

When you feel like your BEST SELF, what makes you feel that way? Think about what are you doing, who are you with and what is occurring in your environment. *

If you woke up tomorrow and a miracle had occurred overnight, and you had your best life and you were your BEST SELF, what would it be? How would it look? What are you doing? Who is with you? *

What might have prevented you from having your best life or from you being your BEST SELF? *

What goal or dream have you given up on or failed at? Also include what you believe made you stop or fail. *

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

What are you most proud of, or excited about in your life right now? *

What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful? *

What eating, exercise, or general health habits would you like to begin in order to feel stronger and healthier? *

What distracts you the most rom being more productive, and what major projects or missions are you struggling to complete faster or more efficiently? *

If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving? *

When you do struggle to be fully present in your day or in any of your relationships? *

How purposeful do you feel in living each day, and how would you describe your purpose? *

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

Why do you feel you could be a great student or coaching client if we worked together? *

Is there any other information you want to add? If a question wasn’t asked but you have information you feel is important to a coaching relationship, please share it here. *

Thank you for taking time to complete this intake survey. Results are confidential between Client and Coach. Your answers will help to identify your current baseline at the beginning of coaching, and will provide insight into your unique coaching experience.While there are set modules in this high performance curriculum, every client brings personal and individual attributes, talents, concerns and goals. Identifying these at the outset is important to moving forward. Congratulations on taking your first step toward Your Best Self!

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