Elisabeth Klein's Coaching Proposal Questionnaire
Just the fact that you are here tells me something about you: you are brave. Truly. Because your first step in making any change in your life is to assess your reality honestly, even if it's painful to do so. The answers you provide on this form will help me understand where you are in your current situation and your overall well-being, and they will provide a great starting point if we decide to work together.  Please note that your answers are confidential. I'll be in touch shortly with a custom coaching proposal. -Elisabeth
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Full Name *
Best email to reach you? *
What is your relationship status? *
What 3 things in your life right now make you the happiest? (this can be anything: your faith, your kids, your pets, talking with friends, long walks alone, watching TV) What are your joys? *
What 3 things in your life right now do you find hard or you're struggling with? (for example, your job, your relationship, parenting, money concerns, your health, fears of the future, not being able to let go of your past) What's stealing your joy? *
Use 3 short word-phrases to describe how you feel about your life right now.  (such as: happy, excited, content, stress-free, or drained, sad, depressed, overwhelmed, bored, frustrated, wanting more...)  Keep them short, but tell me how you're feeling at this time in your life.   *
Use 3 short word-phrases to describe how you'd like your life to be a year from now.  (such as: happier, healthier, relaxed, less stressed, in love again, employed, organized, a better parent or spouse, better relationship with God, having fun). Imagine you were granted 3 wishes. What would they be? *
They say life is a numbers game... so what are your numbers?
Please answer the next few questions based on a scale of 0 to 10. 0 being awful and 10 being perfection.
How are you feeling physically? How is your overall health? *
Awful
Perfection
How is your relationship with God or your spiritual life? *
Awful
Perfection
If you are married, how is that going?
Awful
Perfection
Clear selection
How do you feel you are doing emotionally, or how is your mental well-being? *
Awful
Perfection
How do you best like to learn/interact: (choose as many as you like) *
Required
What topics sound most compelling to what you're wanting to currently work on in your life? *
Required
How ready are you to make some changes and try coaching at this point in your life? *
Not at all, not sure why I even filled this out
1000% ready
Anything else you'd like me to know?
Today's Date *
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