Michelle King Coaching - Initial Questionnaire
I am thoroughly excited and honored to partner with you through your personal transformation as you cultivate self-care practices that support your health and overall well-being. This is the initial step in answering your call to action and asserting your readiness for change.
The purpose of this application is to shed light on your current circumstances and offer an opportunity for us to connect and see if we are a fit. There will be a section at the end of this application for your questions, comments, and any additional information you would like to share before we connect over the phone.
With gratitude and care,
What is your first and last name?
What is your biggest challenge at the moment and what do you want to change?
What would be your DREAM outcome?
Why is achieving this result important to you?
How would life be different if you were living that DREAM now?
How long do you think it will take for you to achieve the outcome(s) you want?
When do you want to start your program?
What is your program availability?
Do you have any specific health concern, condition, or illness? If so, please explain.
How would you qualify your overall satisfaction in life on the scale of 1-10?
How much energy do you currently have?
I'm not sure, I haven't really noticed.
I feel exhausted, drained, and tired all the time.
I feel wired, but tired. It seems like I have a lot of energy, but when (if) I sit still the fatigue hits me.
I feel my energy is balanced.
My energy varies depending on the circumstances of the day.
Which of the following areas of your life do you want to address (check all that apply)?
Mindfulness & Meditation
Pace of Living
Rest and Rejuvenation
How would you describe your current self-care practice?
On the scale of 1-10 (10 being 100%), what is your level of motivation for change at this time?
What might stop you from following through with your program and/or what has stopped you in the past?
What are your special interests and activities you do for fun?
Please list any specific questions, comments, or additional information you would like to share at this time.
You have completed the initial application! Please specify 2-3 days/times that would be most convenient for your 30 minute Discovery Call this week and Michelle will confirm via email. Thank you!
Send me a copy of my responses.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service