Inspirational Coaching


Choose Your Life


Please take the time to fill in your details and answer the questions below to raise your awareness in these important area - have fun and feel free to email us with any insights or questions!


*Full Name:
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*Phone:
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In general, how satisfied are you with your life right now?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied
Are you living the life that you would ideally choose?
Yes No
How often do you stop and consider making changes to your life?
Consistently Regularly Occasionally Rarely
How successful are you at making any life changes that you identify?
Very Moderately Occasionally Rarely Never
How often do you set life goals?
Often Sometimes Never
Would you like to have more opportunity to reflect on your life, set new goals and explore new ideas?
Yes No
How balanced does your life feel right now?
Exactly as I want to be Just about right A bit out of balance Out of control
Where/ to whom are you most likely to look for support when facing a problem?
Spouse / Partner
Work Colleagues
Friends
Coach / Mentor
Other Family
Someone else
Typically, how much stress is in your life?
Just enough More than I would like Far too much
Would you like to improve or make changes to your life?
Yes No
What areas of your life would you like to improve or make changes to?
Health
Finances
Personal Growth
Goal setting / Reflection
Work / Career
Family
Relationships
Feelings
Society I live in
Time for me
Overall, how happy are you with your life?
Very Moderately Would like to be happier Generally unhappy Not at all
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