BreakThrough Life Coaching Questionnaire Name* First Last Phone*Email* Skype: 1. Are you interested in breaking through your barriers and being more effective? If so, what would you hope to achieve over the next 12 months?*2. What are the 3 biggest changes you want to make over the next 5 years? Where would you love to be in 5 years’ time?*3. What 3 goals do you want to achieve in the next 3 months?*4. What feels really good about your life right now? What are the things that make you happy and fulfilled or rested?*5. On a scale of 1-10, how happy are you with your life right now?123456789106. On a scale of 1-10, how happy would you like to be?123456789107. Is there anything that doesn’t feel so great? Is there something missing, or something you are holding onto and can’t let go that’s causing you stress?*8. List 5 things that you are ‘just putting up with’ right now.*9. On a scale of 1-10, how stressed are you in your life and job/career right now?1234567891010. What makes you feel full of energy and renewed with life?*11. What would you say is your greatest 3 achievements in your life to date?*12. On a scale of 1-10, how motivated are you in your life and job/career right now?1234567891013. How does your inner voice speak to you? Is it kind and empowering, or critical and self-sabotaging? What does it say often and repeatedly about you?*14. On a scale of 1-10, how important is getting clarity of your underlying issues?1234567891015. On a scale of 1-10, how important is understanding you ‘Why’, life purpose, and bigger picture vision?1234567891016. On a scale of 1-10, how important is accountability, motivation and encouragement?1234567891017. On a scale of 1-10, how important is breaking old habits and creating positive habits?1234567891018. On a scale of 1-10, how important is defining goals, developing action plans, and identifying challenges?1234567891019. On a scale of 1-10, how important is exploring personal growth and your higher self?1234567891020. On a scale of 1-10, how important is understanding your strengths, character, values, and full potential?1234567891021. On a scale of 1-10, how important is it for you to receive honest feedback and being challenged to improve your life?1234567891022. Is there anything else you would like to tell us about yourself?*23. Do you have any questions you'd like to ask?* Δ
