New Client Questionaire Survey

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.

Instructions: Please answer the questions below and on the following pages to the best of your ability!

	1-Lowest	2	3	4	5	6	7-Highest
Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 1-Lowest	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 2	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 3	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 4	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 5	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 6	Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 7-Highest
Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 1-Lowest	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 2	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 3	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 4	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 5	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 6	Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 7-Highest
Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals?	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 1-Lowest	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 2	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 3	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 4	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 5	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 6	Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 7-Highest
Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world?	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 1-Lowest	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 2	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 3	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 4	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 5	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 6	Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 7-Highest
Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 1-Lowest	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 2	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 3	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 4	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 5	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 6	Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 7-Highest

1-Lowest

7-Highest

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

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 1-Lowest

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 2

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 3

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 4

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 5

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 6

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 7-Highest

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

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 1-Lowest

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 2

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 3

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 4

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 5

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 6

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 7-Highest

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

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 1-Lowest

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 2

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 3

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 4

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 5

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 6

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 7-Highest

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world?

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 1-Lowest

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 2

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 3

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 4

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 5

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 6

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire in the world? 7-Highest

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

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 1-Lowest

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 2

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 3

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 4

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 5

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 6

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 7-Highest

New Client Questionaire

Questionnaire for your Coaching Strategy Session

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* 1. Address

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* 2. Which of the following best describes your current relationship status?

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

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

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

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

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

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* 8. 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?

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

What distracts you the most from being more productive?

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* 10. Why would you like to work with a High Performance Coach?

Question Title

* 1. Address

Question Title

* 2. Which of the following best describes your current relationship status?

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 8. 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?

Question Title

* 9. What negative recurring thoughts, fears or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?What distracts you the most from being more productive?

Question Title

* 10. Why would you like to work with a High Performance Coach?

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

What distracts you the most from being more productive?