Initial Screen Questionnaire
Hello and welcome to Qwest 4 Serenity!

You're applying for an invitation to book a private coaching consultation call with me Coach 'Chelle.

I personally review each application thoroughly. To better assist you, please answer the following questions as truthfully and as detailed as possible. If your application aligns with the services we offer at Qwest 4 Serenity, I will send you in invitation with further instructions.

There are 25 questions.
This application will take approximately 5-15 minutes to complete.

If you would like to proceed, please complete this application.
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Email *
Qwest 4 Serenity, PLLC
Full Name *
Phone Number *
1. What do you consider to be your role in the world you live in? *
2. If there was a secret passion in your life, what would it be? *
3. If there was something you were avoiding or running away from, what would it be? *
4. What motivates you? *
5. How do you tend to sabotage yourself? *
6. What is missing in your life? *
7. What would make life more fulfilling?
8. Do you believe in God, the concept of a higher power or some other reference point? How does this fit into your life? *
9. What does success mean to you? *
10. If you could have anything in the world what would it be? *
11. What do you want the rest of your life to be about? *
12. (On a scale of 1 - 10) , (1 being disorganized and 10 being neat freak) how would you rate your life organization skills? *
13. How rigorous would you prefer to be coached or held accountable? (on a scale from 1 – 10)? (1 is me telling you everything is great and that you will make a million dollars by next week guaranteed without you having to learn or do anything differently; and 10 is having me tell you that you are worthless and won’t amount to crap if you don’t get off your ass(ets) and make something happen). *
14. What do you do to look after yourself (self-care) on a regular basis? *
15. When were you happiest - and - unhappiest in your life? What made it so? *
16. If there was something you knew you should release from your life, but you haven’t yet done it - what would it be and why specifically? *
17. How do you cope with life stressors and/or moments when you feel down? *
18. What do you like to do with your kids and/or family members? *
19. If you could travel anywhere in the world, where would it be and why? *
20. If there was anything else you thought was important for me to know about you or your situation that may have not been asked up to this point, what would that be? *
21. How will you know if you are receiving value from the coaching process? *
22. What are the 3 biggest changes you want to make in your life within the next 5 years? *
23. What 3 goals do you want to achieve within the next 3-6 months? *
24. Is your life one of your choosing? If not, who is choosing it for you? *
25. What is most important to you in your life and why? *
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