Coaching Questionnaire
Coaching Questionnaire
Coaching Questionnaire
*Pl ease t ype r esponses t o al l quest i ons and e- mai l back t o your coach.
Name
GOALS
What are the 3 goals you want to achieve over the next three months?
What are the three biggest changes you want to make in your life over the next three years?
PERSONAL HISTORY
What would you say have been your three greatest accomplishments in your life to date?
What is the hardest thing you have ever had to overcome?
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Who are or have been your major role models? Would you be willing to add some? Why?
What major transitions have you had in the past two years? (i.e. entering or approaching a new
decade of life a new relationship a new job a new role a new residence changes in children!s
ages"stages of life separation divorce death of a loved one birth of a child marriage etc.#
YOUR LIFE
Who are the key people in your life and what do they provide for you?
$s your life one of your choosing? $f not which parts are being chosen for you?
%n a scale of & &' &' ( )$*) provide a number that represents your current level"degree of
stress+
What are your primary stressors?
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,ist five (-# things that you are tolerating or putting up with in your life at present. (i.e. information
you cannot find rude people poor lighting tight shoes dented car job dissatisfaction dead plants
broken e.uipment old appliances etc.#
COACHING YOU
What would you expect or like your /oach to do if you get behind on your goals?
)ow will you know when you are receiving value (i.e. your money!s worth# from the /oaching
process?
What types of approaches discourage you or take away your motivation?
How can your Coach best support you in the Coaching relationship? Using each number once, place the
following in order of importance. Rank using 1-1 !1" #ost $mportant% 1 " &east $mportant'
Brainstorming Strategies Together Insight into Who You re and Your Potentia!
Su""ort# $ncouragement# %a!idation $&"!oring and 'emo(ing B!oc)s and *+stac!es
to Your Success
ccounta+i!it,- .hec)ing u" on /oa!s Wor)ing through Se!f0Im"ro(ement Programs
Together
Suggesting or 1esigning ction Ste"s Painting a %ision of What You .an Become or
ccom"!ish
Strategic P!anning 1irectness2 s)ing 3ard 4uestions-
.ha!!enging You to 5o(e 6or7ard
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POTENTIAL & POSSIBILITY
0o you have a personal or professional vision?
$f so what is it?
What would you like to contribute to the world?
What is a dream or goal you have given up on?
What part of yourself if any have you given up on?
%n a scale of & to &' (&'( )$*)# rate the .uality of your life today+
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Name:
Let Us Know which
Other Anthony Robbins Events/ro!"cts yo" h#ve "se!/#tten!e!
Anthony Robbins seminars you have attended (check all that apply and indicate month and
year attended)
Unleash the Power Within (m/y) Life Mastery (m/y)
Date With Destiny (m/y) Wealth Mastery (m/y)
Strategic Influence (m/y) Leadership cademy (m/y)
Power to Influence (m/y) S!ills of Power (m/y)
"esults #$$$ (m/y) %inancial Power (m/y)
&he 'ompetiti(e )dge (m/y) *ther (m/y)
+usiness Mastery (m/y)
Anthony Robbins products you have purchased (check all that apply)
nthony "o,,ins Power &al!- .et &he )dge
&ime of /our Life Personal Power II
Unlimited Power Unleash the Power Within
wa!en the .iant Within (,oo!/audio) Li(ing 0ealth
&he +ody /ou Deser(e Mastering Influence
Ultimate "elationship Program &he Path to Permanent Weight Loss
"o,,ins1Madanes products2 Ultimate )dge
"eclaiming /our &rue Identity Money Masters
Leadership in &imes of 'risis "PM +inder
'on3uering *(erwhelming Loss 'reating Lasting 'hange
Inner +alance Products2 Pure )nergy .reens
Life +alance Pac! *ther2
Daily )ssentials Pac!
Li(ing Light Pac!
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