1:1 Coaching Client Questionnaire
Please fill out this form completely so we can work through an action plan together. Remember, there are no right or wrong answers. This is a journey through your life.
Contact Information
Name *
Your answer
Email address *
Your answer
Phone Number *
Your answer
Where are you located?
Your answer
How motivated are you to make changes to improve your life? *
Not motivated
Highly Motivated
Are you PREPARED to take the necessary action steps towards your goal(s) & be held accountable in your life? *
Are you currently working with anyone on these goals? *
If so, in what area? If not, Why Now? *
Your answer
Are you EXCITED & READY to work on YOU? *
Are you willing to engage financially & emotionally in a Minimum 3-month Coaching relationship to make sustainable & long-lasting changes in your life? *
How fulfilled/happy are you right now, on a scale of 1-10 (professionally & personally) *
Not At All Happy
The Happiest I've Ever Been
What made you choose the previous answer? *
Your answer
How much stress are you experiencing at this moment? *
Extremely Stressed
Cool as a Fan
What are 3 primary short-term goals you would like to accomplish in the next 90 days. *
Your answer
What long-term goal(s) you would like to work on in our coaching. Only what you Really want & not what you Think you should do. *
Your answer
What would make you feel your most contentment if achieved? *
What motivates you or gives you energy? (caffeine, exercise, deadlines, family) *
Your answer
What do you consider to be your personal and/or professional strengths? *
Your answer
What's barriers are stopping you from having the life you really want (professionally/personally)? *
Your answer
Last Question: Tell me what I should know about you so I can best coach you? *
Your answer
Bonus Question: How did you find me? (check all that apply) *
Statement of Agreement
If you are ready to make change in your life & take the 1:1 Coaching Relationship with Shevaughn Desirée, please complete and sign this registration & select your date request to schedule your FREE 1/2 hr Consultation. I will be in contact with you with the date and time of scheduled your Consultation. Your specified date will be taken into consideration. No guarantees on date, due to pre-schedule coaching clients. Once consultation is complete, & we are a good fit to take this further, the payment link will be sent to you along with a Welcome Packet and Contract.
DATE REQUEST: 1/2 hr FREE Coaching Consultation
Signature *
Your answer
Thank You!
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