Questionnaire: Getting to Know You

Welcome to Coaching Collab™, we are excited to have this new relationship with you. Our goal is to provide you with the best quality of coaching services and resources. The questions below are specifically designed to help with your personal development.

Thank You and Together We Build,

Sandra D. Johnson, CEO—The Madisel Group & Coaching Collab™

First Name

Last Name

Email address

Please review and answer each of the questions.

How did you hear about us?

Social Media

(Facebook, Instagram)

Coach

Friend

What are your goals?

Healthy Communication

Repair Relationships

Financial Restoration

Increase Parenting Skills

Other

Have you received services from a personal life coach before?

Yes No

What is your age range?

21 – 30 31 – 40 41 – 50 51 – 60 61+

When is your birthday?

What is your gender?

Male Female Other Prefer not to answer

Other

What is your ethnicity?

Black/African American White/Caucasian Latino Asian Biracial Other Prefer not to answer

Other

What is your marital status?

Single Committed Partnership Married Divorced/Separated Widowed

Are you planning for a relationship?

Yes No

Are you planning for children?

Yes No

How many people are in your household?

Please indicate the number of family members in each age group:

6 and younger

7-12

13-17

18+

Household income

Less than $20,000 $20,000 – $45,000 $46,000 – $60,000 $60,000 +

Source of income:

Full-time/ Part-time Employment

Personal business Owner

Government Funding

Student

Do you have any religious or spiritual beliefs?

Yes No Prefer not to answer

How would you describe your life?

Living my best life!

I could use a nudge for some direction

Lost without a map to guide me Struggling with circumstances

Other

Finish these sentences

I can do better if .......

People say I am ......

I am worried about .....

Secretly I need .....

Why?

What gives you hope?

Disclaimer:

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