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Complimentary Coaching Questionnaire

Congratulations on taking the next step to discover if coaching is right for you!

Filling out this questionnaire entitles you to a complimentary coaching session. It also indicates your interest in exploring whether business or personal coaching is a match with what you are looking for. There is no obligation or pressure for you to move ahead with coaching. The choice is always yours.

We will spend 20-30 minutes on the telephone exploring ways to help you and your business excel. (In-person sessions are charged a fee and are by appointment only.)

*Indicates required fields  
Name*
Address*
City*
State/Province*
Zip/Postal Code*
Name of Business
Type of Business
Your Position or Role
Years in this business
Office Phone Number*
Home Phone Number*
Fax Number
Your Email*
Web Site Address
Referred By*
If Other, please specify

Your responses to the following questions will prepare us both for our "get acquainted" complimentary coaching call.

Please select all the statements below which are relevant to your circumstances. All information provided will be held in strictest confidence and not shared with any third party.

Personal - check one
I am biding my time until something better comes along.
I dread any more changes.
I am always late for appointments or forget key dates and tasks.
I want to feel passionate about my life or work.
My spouse does not "get" me any more.
I want a higher purpose for my life.
I am financially unable to live the life I want.

Executive - check one
I should use my time more effectively, not over-commit myself, and not have more stress in my life/work .
I want to be able to communicate fully with my people, establish trust, and act with fairness.
I am unable to stay focused on high-return actions/priorities without getting side-tracked by minutia.
I am unsure how to empower my staff.
My staff say I need to be supportive of my people.
I am unsure about making the next change in my career.
I have been recently promoted and am struggling with new people and a new mandate.
My spouse is complaining I work too much.
My workload is overwhelming and I would like to get a different job.
I do not agree with my management team or Board on key issues.


Business - check one
My business has no clear vision of where it is going.
I need to delegate more.
I do not have a strong, supportive professional network.
We do not have a business plan.
We do not know how to grow our business.
Administrative details are taking all my time.
I have a difficult relationship with a co-worker, colleague, boss or employee.

Answer the following questions to the best of your ability.

What is your personal vision?

What is the vision of your business?

In 25 words or less, please write your personal purpose.

If you were to work with a coach, what would you like to change/develop in your life?

What do you want to create or accomplish in the next 3 to 6 months?

What would you like to accomplish in the next 1 to 2 years?

Have you ever worked with a coach or have you coached others? Please explain

What are you putting up with in your life that may be holding you back?

What benefits and/or results do you want to get as a result of being in a coaching relationship?

What time is most convenient for your Complimentary Coaching Session call?

Thank you for contacting us!

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