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Jul. 10th, 2008
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Complimentary Life Assessment
Life Assessment Questionaire
Would you like to get a better idea of what we focus on in coaching sessions? I invite you to fill out this short life assessment. Please take your time, as your responses will be a true indication of what areas in your life you would like to change, or focus on.
My way of thanking you for taking the time to fill out the assessment and for visiting my web site is to offer you a complimentary 25 minute coaching session, called Unleash Your Potential. This session will leave you with tools to empower yourself to make changes and a renewed sense of energy and inspiration.
1. How would you rate the following aspects of your life out of 10?
Health -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Happiness -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Finances -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Career -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Family -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Spirituality -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Friends -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
Significant Other -
1 - Lowest
2
3
4
5
6
7
8
9
10 - Highest
2. Given these scores, which area would you like to focus on in the next 6 months?
3. If you could change one thing in your life right now, what would that be?
4. What is your favorite way of "holding you back"?
Fear -
Procrastination -
Stubborn -
Being Controlling -
Being Timid -
Other -
(please explain)
5. If you had a coach, what do you think would be the most valuable to you?
Sounding Board -
Accountability -
Validation -
Support -
Inspriration -
Clarity -
Ideas -
Other -
(please explain)
6. What are three specific things that you would like to change about your life in the next 3 - 6 months? These can be personal and/or business related.
7. How will your life be impacted when you have these wants and desires fulfilled? How will you feel when you have manifested your desires?
8. What has kept you from already making these changes?
9. What will you miss out on if in a year from now nothing has changed? How will you feel if nothing has changed in a year from now?
10. Where did you hear about Life Is What You Make It and/or Deb Fortier?
Referral
Workshop
Yellow Page Ad
Internet Search
Other
In order to book your free Unleash Your Potential coaching session, we need the following information:
Name:
Email:
Phone number:
and best time to call:
Preferred day of the week and time for free session
Questions / Comments:
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