Coaching for Individuals or Employees: Private One-on-One Questionnaire

Helping individuals balance and enhance their performance and wellness amidst competing priorities and evolving demands.

One-on-One Individual coaching is private and confidential, meaning that employers do not receive information about what is discussed during coaching sessions unless the employee explicitly consents to sharing that information.

Your responses will remain entirely confidential. It's crucial that you answer this questionnaire honestly. The first step toward achieving your goals is to assess your current situation accurately. With this baseline information, we can collaborate to develop a personalized action plan for your success.

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Your Contact Information

Your First & Last Name

Best Contact Phone Number

How did you hear about our services?

Identify the Most Significant Area Affecting Your Performance and Wellness

Choose one

Stagnant/Held Back: "Fearless Alignment". You're ready to uncover what truly drives you and pinpoint the fears and misunderstandings holding you back. Through personal reflection and value realignment, you're ready for a transformative journey that will help you reconnect with your core motivations and desires. You know it is time to stop feeling stuck, embrace self-development, and focus on achieving your true potential. Stress/Overwhelm: “Mastering Mindfulness” . Your life is overwhelmingly busy, making it a struggle to stay ahead. This interferes with your ability to perform and leaves you stressed. You’re ready to identify the root causes of distress and get unstuck. Mental Fatigue/Burnout: “Exhausted to Energized” . You’ve been overwhelmed and stressed for so long that it’s taking a toll on your mental faculties and physical stamina. You’re ready to boost your performance and enhance your wellness. Disengaged/Unhealthy Habits: “Transform Self-limiting Beliefs & Self-Sabotage” You’ve felt challenged and stagnant in your performance, with depleted energy leaving you constantly drained. Your habits are negatively impacting your personal and professional life. You’re ready to realign, restore, and rebalance for self-discovery, relief, and a positive outlook. You want to boost your confidence, regain your energy, and become the best version of yourself. Other: You’re unsure of exactly what you need, but you know you need support and guidance. You’re ready to take the first step, gain clarity, and start making meaningful changes.

If other, please describe your specific area of concern or need

Questions to Help Illuminate the Path

1. Did your employer ask or require you to seek coaching for performance improvement? Please explain, what is the reason?

2. Have you established a relationship with a Licensed Medical Provider (MD, NP, PA) for your medical wellness needs? If yes, when was your last wellness checkup (I.e. yearly labs, blood pressure)?

3. Which of the 3 areas is most important to you and a priority to address now?

4. What are your top priorities you aim to achieve?

5. What are your main reasons for committing to making a change in your life in this moment?

6. What is currently holding you back, presenting obstacles or challenges?

7. How do you plan to be present, show up to make realistic, and sustainable changes?

8. What stage are you at in investing in your performance and wellness?

9. What is your experience with coaching?

10. What success have you achieved participating in other coaching programs?

11. What type of physical and emotional encouragement do you need from your support system to achieve your goals?

12. How much time can you realistically dedicate to your transformation process (weekly, bi-weekly, monthly)?

13. What additional information would you like to share to ensure the best experience?

Coaching Program Options

14. Which coaching programs are you interested in? (Select all that apply)

1-Hour Laser Focus

One-Day Strategy Focus

One-Week Intensive Program

One-Month Program

Two-Month Program

Three- Month Program

Six-Month Program

Investment

15. Which level are you at and willing to invest in your performance and wellness?

$2,399 - $5,999 $6,000 - $10,999 $11,000 - $50,999 $51,000 - $150,999 $151,000 and over

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