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For each of the following life areas, how would you rate your own on the scale of 1 to 10 (10 being the absolute best)
Career
Family
Friends
Significant Other/Romance
Fun/Recreation
Personal Growth
Health
Physical Environment (House, Car, etc)
Money
Given the scores above, improving which two areas would make the biggest difference to your life?
Career
Family
Friends
Significant Other/Romance
Fun/Recreation
Personal Growth
Health
Physical Environment (House, Car, etc)
Money
What is one BIG goal you want to achieve in the next six months?
What are three things that you have to put up with consistently in your life now?
Assuming everyone has a way of holding back or sabotaging his/her own life, what is you favorite method?
Procrastination
Difficulty making decisions
Arrogance
Not being able to say "no"
Tolerating things
Controlling life/people
Not being able to say "yes"
Fear of failure
What would be the most valuable thing you would want to get from coaching?
Challenge
Accountability
Focus
Support
Inspiration
Direction
Sounding board
Ideas/Strategies
Validation
Additional Comments
Full Name
E-mail
Phone Number
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