C o a c h i n g Q u e s t i o n n a i r e . d o c
P a g e 1 o f 4
■ C O A C H I N G Q U E S T I O N N A I R E
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* P l e a s e t y p e r e s p o n s e s t o a l l q u e s t i o n s a n d e - m a i l b a c k t o y o u r c o a c h .
A l l I n f o r m a t i o n i s P r i v a t e & C o n f i d e n t i a l .
Name Email Phone Number Date of Birth
Address
How Did You Hear About Me?
Search Engine Coach Federation FindaCoach.com FaceBook Friend Other (please note)
GOALS
What are the 3 goals you want to achieve over the next three months?
What are the three biggest changes you want to make in your life over the next three years?
PERSONAL HISTORY
What would you say have been your three greatest accomplishments in your life to date?
What is the hardest thing you have ever had to overcome?
Who are or have been your major role models?
C o a c h i n g Q u e s t i o n n a i r e . d o c
P a g e 2 o f 4
What major transitions have you had in the past two years? (i.e. – entering or approaching a new
decade of life, a new relationship, a new job, a new role, a new residence, changes in children’s
ages/stages of life, separation, divorce, death of a loved one, birth of a child, marriage, etc.)
YOUR LIFE
Who are the key people in your life and what do they provide for you?
Is your life one of your choosing? If not, which parts are being chosen for you?
On a scale of 1 – 10, 10 = HIGH, provide a number that represents your current level/degree of
stress:
What are your primary stressors?
List five (5) things that you are tolerating or putting up with in your life at present. (i.e. – information
you cannot find, rude people, poor lighting, tight shoes, dented car, job dissatisfaction, dead plants,
broken equipment, old appliances, etc.)
COACHING YOU