Q'aire

New Client Questionnaire
You can begin your "Life By Design" (vs. life by default) process now!
Complete the questions you can quickly answer on this confidential questionnaire.
Then click "Submit" at the bottom and I'll be in contact with you promptly
to schedule your Introductory Consultation!

Name *

First

Last

Email *

Preferred Method(s) of Communication (phone, email and/or Skype?) *

Phone Number(s), Skype Name if applicable, and best days / times to call: *

1. What is your Big Dream/Vision? *

2. What stands between you and this Big Dream/Vision? *

3. What crisis are you in NOW? *

4. What results are you looking for from the coaching process? *

5a) From the "WHEEL OF LIFE" -- On a scale of 1-10 (low to high), how would you rate your level of satisfaction in the area of Health and Fitness? *

5b). Recreation and Fun? *

5c). Spirituality *

5d). Creativity *

5e). Primary Relationship *

5f). Family *

5g). Social and Friendships *

5h). Money Management *

5i). Business and Career *

5j). Income Now *

5k). Growth and Learning *

6. What area(s) do you want to focus on? *

7. What is your current occupation(s)? *

8. What are you most proud of accomplishing to this point in your life OR what is the most difficult experience you have overcome? *

9. Your Mission: What type of change would you like to create in the world with your life? *

10. Your Passion: If you had enough money to cover your bills every month, what would you do to contribute as your gifts to the world? *

11. Your Issue: What single issue drains your energy most; (what would most dramatically change your quality of life if you woke up and this was perfect)? *

12. Education/Business Background: What education, professional courses and/or experience do you value most? *

13. Spiritual Background: What training, study, practice and/or experiences have been most life-giving for you? *

14. Are you committed to doing your "inner homework" between coaching sessions? *

15. What else do I need to know about you—your preferences, learning style, communication style, sensitivities, etc? *

BONUS QUESTION: What are your favorite musical instruments, sounds or style(s) of music? *

Your questions or comments: *

Submit

Congratulations on completing this first step!

New Client QuestionnaireYou can begin your "Life By Design" (vs. life by default) process now! Complete the questions you can quickly answer on this confidential questionnaire. Then click "Submit" at the bottom and I'll be in contact with you promptly to schedule your Introductory Consultation!

New Client Questionnaire
You can begin your "Life By Design" (vs. life by default) process now!
Complete the questions you can quickly answer on this confidential questionnaire.
Then click "Submit" at the bottom and I'll be in contact with you promptly
to schedule your Introductory Consultation!