One-on-One Coaching Questionnaire Name First Last Email If you clicked on other in the previous question, write down where you heard about me. If you were referred to me, please write the name of the peson who referred you so I can thank them! 1. Please, describe the reasons you are consulting a lifecoach at the moment.2. What are you hoping to accomplish with coaching/mentoring?3. Have you ever consulted a coach or therapist in the past? If yes, when, how long and for what reasons?4. Have you ever tried to commit suicide or had suicidal thoughts in the past? (please, contact your info-suicide line therapist or emergency services if it happens during our coaching sessions.)5. Do you have an emotion that surfaces more than others these days? If yes, what is it?6. Do you have a pain in your body? If yes, where and how long as it been there?7. On a scale of 0-5, 0 being not important and 5 being very important, how strong are these life areas affected by the situation you are consulting with me? Marriage/Personal Relationship 1 2 3 4 5 Family 1 2 3 4 5 Financial Situation 1 2 3 4 5 Physical Health 1 2 3 4 5 Emotional Health 1 2 3 4 5 Friendship 1 2 3 4 5 School or Work Performance 1 2 3 4 5 Concentration 1 2 3 4 5 Sleep 1 2 3 4 5 Sexual Desire 1 2 3 4 5 Untitled UntitledUntitled
