Free Coaching Session - Preliminary Questions

GOAL: To Help you reach heightened levels of clarity, energy, courage, productivity, and influence on your march to a successful, healthy, and fully charged life.

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Please answer the questions below and on the following pages to the best of your ability. We will both receive a copy of your responses at the end.

Question 2 of 28

Please Provide Contact Information

Full name
Phone number
Email address
Street Address
City, State/Province
Zip/postal code

Question 3 of 28

More about you

Date of Birth
Marital Status

Question 4 of 28

Please briefly describe how you heard about my coaching services and why you would like a Strategy Session with me.


Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest)

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Enter a number below of 1 (lowest) to 10 (highest),

Do you feel that you are clear about who you are, your purpose, and the direction you want to go in life?

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Enter a number below of 1 (lowest) to 10 (highest),

Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?

Question 8 of 28


Enter a number below of 1 (lowest) to 10 (highest),

Do you take action to consistently express who you truly are and what you truly think, need, and desire with the world?

Question 9 of 28


Enter a number below of 1 (lowest) to 10 (highest),

Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?

Question 10 of 28


Enter a number below of 1 (lowest) to 10 (highest),

Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?

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1. What do you do for a living, and why did you choose that career?

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2. What are your top 3 goals you are striving to achieve right now?

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3. What major stressors or challenges are you struggling with right now?

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4. When you feel like your most successful and happy self, what makes you feel that way?

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5. What would your dream life look like if you could wave a wand and make it happen?

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6. What else has prevented you from having that dream life?

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7. What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?

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8. What 3 big changes would you like to make in your life in the next 12 months?

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9, What are you most proud of and excited about in your life?

High Performance Questions

Personal Performance Questions

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1. What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident, and successful?

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2, What eating, exercise, or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?

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3. What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster, or more efficiently?

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4. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

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5. When do you struggle to be fully present in your day or in any of your relationships?

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6. How purposeful do you feel in living each day, and how would you describe your purpose?

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7. Why would you like to work with a high performance coach?

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8. Why do you feel you could be a great student or coaching client if we worked together?

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