Spirited Health

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Spirited Health

Pre-Coaching Questionnaire

Note: All personal information is confidential, and held securely in accordance with the appropriate legislation.

Address

please include City, State and Zipcode

Option 1

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Occupation

Phone number

Please choose best contact number

Full Name

Please include prefix (Miss./ Ms. / Mrs./ Mr.) and suffixes (Jr./ Sr.)

Martial Status

Significant others name

Do you have Children?

Yes

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What are your top 3 things that you’re feeling you struggle with?

What is going on for you in your life right now?

How do feel like you are living your life, or dealing with your life situation?

Now rate this on a scale of 1-10

I am having great difficulty

I am doing great

Clear selection

How does that make you feel, be, or think?

What would you like it to be different?

How would you like to feel, be, or think?

How have you tried to make a shift or change things before? Did you have any success?

If not, why do you think it didn’t work?

Why do you want to make a change?

What is your biggest fear, or obstacle you will face when making the shift?

How ready are you to make that change on a scale of 1-10?

I don't know if I am

SO ready!

Clear selection

What type of support do you need from me?

Why did you choose to work with me as your coach?

How did you hear about me?

Untitled Title

Note: All personal information is confidential, and held securely in accordance with the appropriate legislation.

Thank you for taking the time to complete this questionnaire prior to our session.

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