—-Coaching Questionnaire (Sample)

    Please mark your preference for occasional follow up communication from our office:
    EmailPhone

    Sex:
    MaleFemale

    Civil Status:
    MarriedSingleWidowDivorced

    Employment Status




    Are you ready to make changes now?

    Whole Life Scale

    Career – 1-10

    Health – 1-10

    Physical Activity

    Finances – 1-10

    Spirituality – 1-10

    Joy – 1-10

    Love Life – 1-10

    Social Life – 1-10

    Relationships – 1-10

    Creativity 1-10

    Home Environment – 1-10

    Service to the world– 1-10

    How did you hear about Life Empowered Coaching?
    WebSocial MediaReferral

    Do you have people in your life that support you in your journey?
    YesNo

    Have you experienced any trauma in your life?
    YesNo

    How willing are you to grow and change 0-10 (unwilling-willing)*