Questionnaire – Breakthrough with Coach Pete

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Coach Pete

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Home
Meet Coach Pete
- Testimonials
- Coach Pete’s Book
The Coaching Process
- Personal Growth
- Career
4th Quarter Life Coaching
MENtor
Blog
Contact

Let's break/through together

get started with our
confidential intake coaching questionnaire

Name *

First

Last

Layout

Email *

Your Age Range

Phone *

Education

What do you like about your work, and what do you dislike?

What is your proudest accomplishment and/or the most challenging experience you have ever overcome?

What is your life’s vision/mission – what do you want to contribute to the world?

What is your greatest passion in life – something that comes easy to you and does not feel like work, it just feels good?

How satisfied are you with your life?

Please rate each of the following areas on a scale of 1-5.

Layout

Health and Fitness:

5
4
3
2
1

Learning and Growth:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Primary Relationship:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Friendships and Social Life:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Recreation and Fun:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Career and Business:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Family Relationships:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Professional Relationships:

5
4
3
2
1

Please rate each of the following areas on a scale of 1-5.

Are you on any prescription medications?

Yes
No

If yes, what medications and why?

What results are you looking for from coaching?

What are your definitions of commitment and accountability?

How committed are you to being accountable and doing what it takes to achieve the results you desire?

What else would you like me to know about you?

BREAKTHROUGH
WITH
COACH PETE

cONTACT

Phone:
845-642-1839
Email::
breakthroughwithcoachpete@gmail.com

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