Client Questionnaire

As your coach, it is important to understand who you are, what you value and how you approach life. These questions that are designed to make you stop and think about who you are and what you really want out of life. Please take a few minutes to consider these questions.

Please Enter Your Name
Business Name
Mailing Address
City/State/Zip
Primary Telephone #
Cell or Secondary Telephone #
Email
Birthday

1. What three things would make you ecstatic if you were able to accomplish them in next 90 days?
1) 2) 3)

2. What would you like more of in your life? (Money, Time, Creativity, Friends, Energy, Travel etc)

3. What is present in your life for which you feel grateful?

4. List a couple of things that you feel like you are tolerating but would rather not?

5. What would you like me to know that will help me coach you better?

6. If you were given six months to live, how would you spend your time?

7. 3-6 month Action Items: List seven things that you think you would like to do in the next 3-6 months
that would make you feel like you are having a rich life. These can be goals, adventures, things that
you are accomplishing, anything!
1) 2) 3) 4) 5) 6) 7)

8. Life Goals: Begin making a list of life goals that you can see yourself doing and list the year
that you feel that you will be doing them. The list can be as long or as short as you like.

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