Please complete this questionnaire prior to our call.
1. How fulfilled are you with the choices you've made in the last 6 months?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Very fulfilled and am on my desired path\nSomewhat fulfilled but feel I'm missing something\nNot fulfilled and feeling lost"}
2. Complete the following:
My greatest strength, gift or talent is...
{"type":"textarea","name":"__generic2","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What holds me back is...
{"type":"textarea","name":"__generic3","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
3. Rate how satisfied you are with: (1 lowest; 5 highest)
Spiritual life
Select rating12345{"type":"select","name":"__generic4","width":25,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select rating\n1\n2\n3\n4\n5"}
Health
Select rating12345{"type":"select","name":"__generic5","width":25,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select rating\n1\n2\n3\n4\n5"}
Relationships
Select rating12345{"type":"select","name":"__generic6","width":25,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select rating\n1\n2\n3\n4\n5"}
Career
Select rating12345{"type":"select","name":"__generic7","width":25,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select rating\n1\n2\n3\n4\n5"}
4. How much stress is in your life right now? (1 lowest; 5 highest)
Select rating12345{"type":"select","name":"__generic8","width":25,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Select rating\n1\n2\n3\n4\n5"}
What causes you stress?
{"type":"textarea","name":"__generic9","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
5. What are the biggest changes you would like to make in the next 6 months?
{"type":"textarea","name":"__generic10","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
6. What is currently getting in the way of achieving these goals?
{"type":"textarea","name":"__generic11","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
7. Have you worked with a coach before?
{"type":"radio","name":"__generic12","width":15,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Yes \nNo"}
8. Complete the following:
What I most desire to gain from coaching is...
I have these expectations of my coach... {"type":"textarea","name":"__generic14","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
9. What services would you like to explore?
{"type":"checkbox","name":"ServicesSelected","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Leadership Coaching\nTeam Mentoring\nAssessments\nCulture Consulting\nOther"}
If "Other" is one of your selections above, or you'd like to elaborate on another selection(s), please describe here.
{"type":"textarea","name":"__generic15","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
10. Commitment is essential to achieving desired changes. Please share why you're committed to what you seek?
{"type":"textarea","name":"__generic16","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"A few ideas...why coaching is essential for you right now, how strongly you feel about attaining your goals, and/or what you will do if you feel tempted to stop mid-stream."}
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