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  1. Surveys
  2. 2015
  3. March
  4. S
  5. Self Discovery
0%
Questions marked with an * are required Exit Survey
 
 
* 1. Rate yourself from one to ten in each of these life areas.
   
* Health
   
* Emotional
   
* Mental
   
* Spiritual
   
* Family
   
* Relationship(s)
   
* Finances
   
* Career
   
* Peace
   
* Fulfillment
   
* Fun
   
* Other
   
 
 
 
2. What is one thing you would like to achieve in the next six months that would make the biggest difference in your life?
   
 
 
 
3. If you could have more of one thing in your life, what would it be?
   
 
 
 
4. What are the top three things you are tolerating or putting up with in your life?
   
 
 
 
5. How would your life be different if you no longer had the above tolerations?
   
 
 
 
6. To increase your enjoyment of life, what are the three key areas for you to focus on for your own personal development?
   
 
 
 
7. Write down one thing you would like to have in your life but don’t have a clue how to go about getting it.
   
 
 
 
8. Assuming all human beings have some way of sabotaging their life, or holding themselves back, what has been your favorite method?
(Choose your favorite, and write in any that are missing)
 
Procrastination
 
Indecisiveness
 
Arrogance/The Need to be Right
 
Tolerating
 
Acting as the “Lone Ranger”
 
Not always telling the absolute truth
 
Not saying “No”
 
Not saying “Yes”
 
Controlling life/people
 
Following secondary goals (i.e. goals that won’t ultimately make me happy)
 
Other:
 
 
 
9. What would be the most valuable thing you would get from working with a coach?
   
 
 
 
10. Are you ready to hire a coach? Enter Yes No
   
I am ready to do whatever it takes to reach my goals
   
I am willing to listen to someone else’s viewpoint
   
I am willing to invest in myself
   
I am willing to get out of my comfort zone and try new things
   
I am willing to fully commit to make the changes I am seeking
   
I am willing to commit to the process, knowing that change doesn’t happen overnight.
   
I am willing to ask for support and accept the support I receive
   
I am willing to stop tolerating
   
I am ready to invest in myself
   
I am ready to make my goals a top priority
   
 
Give yourself one point for every yes you circled and 0 points for every no, and tally up your total number of points. Your Total:_______
If you scored:
8-10 points......You are ready to make the investment and hire a coach! Your commitment level is high and you will achieve a lot from working with a coach.
5-7 points........You are almost there. During your trial session work with your coach on areas that are getting in your way and ask them to support you in removing those blocks so you can move forward and begin to create the changes you want.
0-4 points........You are probably not ready to hire a coach. During your trial session ask the coach for ideas of what you could do to prepare yourself to begin the process of change.

After you have filled out the form, set up a trial session with a coach and discuss what you discovered by completing this form. Even if you are not ready to hire a coach, this will give you an opportunity to explore the possibilities that are available to you right now. We know that you are capable of achieving anything you choose to imagine and look forward to building a long lasting relationship of Progress and Success that will benefit you and your loved ones for a lifetime.

For more detailed information, visit our website at www.ChosenCoach.com, Send us an email at [email protected], Or contact one of our Chosen Peer Coach Specialists at (203) 442-6633. Thank you for taking this time to invest in you, and to get to know us and yourself a little better. And Remember A, B, C- Always Be Chosen! Help us to Help You and Make Dream Become Reality.
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