Coaching Questionnaire

I have developed simple protocols to empower you to charge your battery yourself. Simple but powerful tools to revitalize your being so that you can function at your optimal level. That’s true success!

Below are a few questions to get us started. After you have submitted this questionnaire I will contact you to schedule our complimentary 30 minute consult. The purpose of this call is to learn more about one another and discover if my program can help you attain your true brilliance!

Name

First Name

Last Name

Phone

(###)

###

####

Birth Date

YYYY

Do you currently have a self care practice? If so what does it entail?

If you currently don’t have a self care practice how much time are you willing/able to dedicate per day?

How would you describe your sleep at night?

How much time do spend on self care per day?

What are your hobbies/interests?

Whats your energy level like throughout the day? Would you like to see it improve?

Do you suffer from chronic pain?

What feeds your soul?

On a scale from 1-10, 1 don’t care and 10 highest priority, how important is it that you feel and look your absolute best?

Coaching Questionnaire