Life Design Coaching Program Application
Please answer the following questions to help me get to know you, and to determine if you are ready for Life Design Coaching!
Email address *
Client Name: *
Your answer
Phone: *
Your answer
Email: *
Your answer
Address (City/Province in which you are located) *
Your answer
Preferred Session Delivery Method *
I am interested in Life Design Coaching because.. *
Your answer
Do you feel you are ready to make big changes and do the hard work involved with redesigning your life? Why or why not? *
Your answer
When would you be ready to start the intensive coaching process? *
Your answer
If that timeframe couldn't be accommodated, when would your next preference be (by month/year)? *
Your answer
How ready do you feel you are? *
Not ready at all!
As ready as I will ever be!
The areas of my life where I feel satisfied are:
Your answer
The areas of my life where I feel dissatisfied are:
Your answer
Some of the things that bring me joy in my life are:
Your answer
Some of the things that stress me out are:
Your answer
Some of the goals I have are:
Your answer
My biggest challenges in life right now are:
Your answer
I think Life Design Coaching will help me:
Your answer
In my life I really wish I had more:
Your answer
In my life I really wish I had less:
Your answer
On a scale from 1-10 I would rate my current stress level as: *
Calm and Centered
Stressed and Overwhelmed
On a scale from 1-10 I would rate my current dissatisfaction with my current life as: *
Not really that dissatisfied, things are pretty good
Extremely dissatisfied
Outside of 1:1 sessions please indicate how much homework/assignments you would like and are able to commit to? *
How are you best motivated? *
Your answer
What would a great coach look like to you? *
Your answer
Have you ever worked with a Life/Wellness Coach before? *
Where would you like sessions to occur? *
Required
Is there anything else you would like me to know about?:
Your answer
How did you find out about Life Design Coaching? *
Your answer
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