Cusp of Life - New Client Questionnaire
The purpose of this questionnaire is for me to gain information about you to be able to better serve your specific needs and also to raise your awareness as to what you would like to get out of your Cusp of Life experience.

If you would like to discuss before filling out this form, I would love to chat with you to see if my Accountability Coaching Program would be a good fit for you. Please contact me to set up a call: nicole@cuspculture.com
Email *
Name *
Phone *
What type of services are you looking for? *
Required
Celebrate your willingness to take the next step. Please answer each question honestly, the best you can.
What is most important to you in your life and why?
Who are most important to you in your life – what do they provide you with?
What are the 3 biggest changes you want to make in your life over the next 5 years?
What 3 goals do you want to achieve within the next 3 months?
If anything was possible what would you wish for?
What have been your 3 greatest successes to date?
What is the greatest challenge you have had to overcome?
What major changes have you been faced with over the last couple of years?
Is your life one of your choosing? If not, who is choosing it for you?
On a scale of 1 -10 how happy are you with your life right now?
Clear selection
What are the things that make you happy?
On a scale of 1-10 how motivated are you in your personal life?
Clear selection
On a scale of 1-10 how motivated are you in your work life?
Clear selection
What motivates you?
On a scale of 1 -10 how stressed do you feel right now?
Clear selection
What are your key stressors?
List 5 things that you feel you are ‘putting up with’ right now?
What approaches motivate or demotivate you?
How would you like me to approach you if you are struggling with your goals?
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