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Pre-Life Coaching Questionnaire

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

E-mail Address*
E-mail Address*

Country*
Country*

Home Phone*
Home Phone*

Business Phone*
Business Phone*

What do you wish to achieve through coaching?

What is stopping you from achieving those things?

What motivates you and gives you energy?

What are you NOT passionate about?

What are you putting up with in your life that you wish you were not experiencing?

What are you grateful for?

What are you missing in your life right now?

Imagine yourself at the end of your life. What would you have achieved so that you would consider your life to have been fulfilled?

What is your spiritual belief?

Is there anything that I need to know about your physical or mental health that is relevant for our coaching sessions?

Coaching Style

	Direct and to the point
	Break it to me gently
	Help me get it on my own

How will you measure the success of this coaching programme? (i.e. removing a negative state, changing careers, a particular achievement, putting a savings plan in place, etc.)

Coaching Days

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

Coaching Times in GMT (Greenwich Mean Time)

	7:00
	8:00
	9:00
	10:00
	11:00
	noon
	13.00
	14.00
	15.00
	16.00
	17.00
	18.00
	19.00
	20.00

Coaching Packages

	Two 45-minute Sessions US$300
	Five 45-minute Sessions US$650
	Ten 45-minute Sessions US$1,125

Please enter the word that you see below.

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