Pre-Coaching Session Questionnaire
Please complete this questionnaire 48 hours prior to your Conscia Strategy Session.
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Email *
Let's start with the basics
Your Name:   *
Occupation: *
Phone Number: *
City: *
State: *
Country: *
Gender: *
Marital Status: *
Okay, are you ready?  Let's light this rocket!
What had you be interested in a coaching strategy session? *
If you would, please briefly describe how you heard about my services, or what it was about our connection when we met, that had you decide to book a coaching session with me.
First, let's do a diagnostic on five critical areas of your life
Rate yourself in these areas of your life on a scale of 1 to 10:
Clarity: *
How clear do you feel about who you are, about what matters most to you right now and clear on the specific actions, projects and focus areas that are effectively supporting you moving in the direction you want to go in life?
(10 = Highest)
Energy: *
Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?
(10 = Highest)
Courage: *
Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?
(10 = Highest)
Productivity: *
Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?
(10 = Highest)
Influence: *
Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?
(10 = Highest)
Next, where do you see yourself in terms of your current sense of Purpose, Passion and Performance in your life?
Do you have a clear sense of your Purpose in life? If so, are you able to communicate it to others clearly? How well do you feel you are consistently expressing your unique Purpose daily, in all aspects of your life?
(10 = Highest)
How would your describe your life's Purpose, as you see it?
What would your dream life look like if you could wave a wand and make it happen? *
What has prevented you from having that dream life? *
What are you most proud of and excited about in your life? *
How clear are you on what you're most passionate about in life? Are you consistently making time and exploring opportunities to express your personal Passion in ways that are meaningful and fulfilling to you?
(10 = Highest)
What are the most Passionate about in life right now? *
What 3 big changes would you like to make in your life in the next 12 months? *
When you feel like your most successful and happy self, what makes you feel that way? *
What do you do for a living, and why did you choose that career? *
Do you have a clearly defined model or strategy to ensure that you are consistently making measurable forward progress in the areas of life that matter most to you?
(10 = Highest)
Why is increasing your level of Performance important to you? *
What are your top 3 goals you are striving to achieve right now? *
What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail? *
What major stressors or challenges are your struggling with right now? *
Let's keep it real right from the start. How can I best serve you?
Why would you consider having a coach? What specific outcomes would you want to see happen? *
Any other curiosities, questions or comments?
Thank you for completing this Questionnaire!
These answers will help provide the absolute best value that I can during our upcoming session. Once received, unless you've already grabbed a time on my calendar, I'll be in touch within 48 (business) hours to schedule our appointment.
 © Conscia Ventures 2023. Some components of this form are based on proprietary concepts from High Performance Institute’s Certified High Performance Coaching Program TM.  Do not duplicate or distribute without permission.
A copy of your responses will be emailed to the address you provided.
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