Client Questionnaire


Client Questionnaire

Review the following statements and record one point for every statement that you strongly agree with, then total the number of points:

1. I am a working professional, currently quite busy.

2. I have developed a healthy program for my lifestyle to be optimal, but am still struggling with planning, motivation, or fully implementing this into my daily life.

3. I am interested in wellness coaching with someone with a high level of expertise, knowledge in evidence-based practices, and someone who is results-driven.

4. I like weekly or biweekly coaching to optimize my performance and wellness.

5. I am good at many things but am struggling to understand my closest relationships; I am interested in developing better communication skills, greater self awareness, and enriching my personal connections.

6. I would like to experience happiness at work. I would like to feel authentic energy related to my values that I bring into my career and chosen profession.

7. I have a stable home, stable finances, stable career, and many stable long term relationships.

8. I follow through on action-oriented plans.

9. I enjoy working with intellectual and well-informed professionals who are knowledgable, refined, calm, clear and direct.

10. Due to a certain stability in my life and in my self, I am able to do deeper transformational work that welcomes me to face my fears and move past these with determination, curiousity, and resilience.

11. I understand that wellness services are not the same as psychiatric services.

12. I am excited to work towards a full confident brilliant self.

If your total is 7 points or more and includes “strongly agree” for numbers 1, 7, 9, 10, 11 and 12, we are likely to work well together.

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