Questionnaire for your Coaching Strategy Session

Goal: To help you reach heightened levels of clarity, energy, courage, productivity, and influence on your march to a successful, healthy, and fully charged life.

Please answer the questions below and on the following pages to the best of your ability.


Name *
Address *
Gender *
Marital Status *
Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest):
Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? *
Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? *
Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? *
Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? *
Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals? *
High Performance Questions: