Complimentary Life Assessment


This is a tool to help you assess what areas in your life need coaching. It will give us a better idea on what we can focus on in our future coaching sessions. Please take a few minutes to fill-out the form completely. Your honest to goodness answers will enable us to help you later in achieving that desired change and results in your life.

Your Name (required)

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1.) How would you rate the following aspects of your life? 10 being the highest.
Health                 
Happiness          
Finances            
Career                
Family                 
Spirituality           
Friends              
Significant other

2.) Given the rating above, which life areas would you like to focus on in the next six months?

3.) What are the habitual pattern that holds you back from completely fulfilling your goals?
 Fear
 Procrastination
 Stubborn
 Being controlling
 Being timid
Others

4.) Working with your coach, what do you think is the most valuable input for you?
 Sounding Board
 Accountability
 Validation
 Support
 Inspiration
 Charity
 Ideas
Others

5.) Give three (3) specific things (business/career/personal) you like to change in your life in the next 3-6 months.

6.) How will your life be impacted when you have these desires fulfilled? How will you feel when you have realized your desires?

7.) Aside from the habitual pattern, what else has kept you from already making these changes?

8.) A year from now, what will you miss out if nothing has changed? How will you feel about it?

Questions / Comments: