Life Coaching Questionnaire

 
Feel free to fill out as much or as little of the following. When you have completed it, you can either mail the form ONLY to yourself, or send it to me as well.  
 
If you choose, we can then set up a call to discuss any of the items on the form, free of charge and without obligation.  
 

List 10 things you would like to accomplish this year:

 

Of these, which 3 are most important to you?

 

What will change in your life when you have accomplished these 3 goals?

 

My Work Life is / isn't Balanced with my Personal Life:        
All WorkWork +BalancedLife +All Personal Life
 

My work occupies more of my effort than my family?
All WorkWork +BalancedFamily +All Family
 

If you had more personal time, what would you do with it?

 

What do you do for recreation?

 

Do you feel you make enough time for recreation?
YesNo
 

Complete the sentence:-
"If I could _________ I Would __________"

 

Your Name:		(optional)
Email Address:
Telephone number:		(optional)

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