Complimentary Coaching Session - Life Balanced

Book your Complimentary Coaching Session with Chad Gutierrez now.

Duration: 1 hour
Date:
Time:
Continue
Name: *
Email: *
Cell Phone: *
City: *
State: *

Coaching Deep Dive 


Welcome to the catalyst for your transformation!

Answer the questions below and be as honest and vulnerable as possible to help me deliver a world class coaching experience for you.


What is your date of birth?

{"type":"text","name":"birthday","width":30,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"DD/MM/YY (ex: 03/11/83)"}


Spouse or Partner's Name?

{"type":"text","name":"partnerName","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"Name and Relationship"}



Children, names and ages?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Child(s) Name and Age, Child(s) Name and Age, etc. "}




Any other information you'd like to share to help me better get to know you?
{"type":"textarea","name":"additionalInformation","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Pet cats, dogs, birds, squirrels, rocks! Favorite hobby? Tragic backstory?"}





How would you describe your satisfaction with your life direction so far?


{"type":"textarea","name":"lifeSatisfaction","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What words describe how you feel about your career?

{"type":"textarea","name":"careerSatisfaction","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}





What compliment or acknowledgement do you hear most about yourself?

{"type":"textarea","name":"compliments","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What dream of yours is still unfulfilled?

{"type":"textarea","name":"unfulfilledDreams","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What words describe you at your best?

{"type":"textarea","name":"atYourBest","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What words describe you when you are less than your best?

{"type":"textarea","name":"lessThanBest","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What activities have meaning and heart for you?

{"type":"textarea","name":"activitiesMeaning","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



Imagine you can have one wish fulfilled. What one thing would you change?

{"type":"textarea","name":"wishFulfillment","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}





What approaches encourage or motivate you?

{"type":"textarea","name":"approachesInspire","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What approaches discourage or de-motivate you?

{"type":"textarea","name":"approachesDislike","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



How will you know you are receiving value from this coaching relationship?

{"type":"textarea","name":"whatResultstoSee","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}






Who are or have been major role models in your life?
{"type":"textarea","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What are the top 3 greatest accomplishments in your life to date?
{"type":"textarea","name":"__generic3","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What are the hardest and biggest challenges you have overcome in your life?
{"type":"textarea","name":"__generic4","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What would your dream life look like personally and professionally?
{"type":"textarea","name":"__generic5","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What are the top 3 goals you want to achieve over the next 3-6 months?
{"type":"textarea","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What have you done or tried already to accomplish your goals?
{"type":"textarea","name":"__generic7","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What are the 3 biggest challenges you foresee to accomplishing the above three goals?
{"type":"textarea","name":"__generic8","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



How might you get in your own way?
{"type":"textarea","name":"__generic9","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What ended up happening the last time you tried to make a major life change? How might have you contributed to the result (positively or negatively)?
{"type":"textarea","name":"__generic10","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What if any major transitions have you had in the past 12 months?
{"type":"textarea","name":"__generic11","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



What are your primary stressors in life?
{"type":"textarea","name":"__generic12","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}



How many alcoholic beverages per week on average do you consume?
{"type":"radio","name":"__generic13","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"None or rarely ever\n1-3\n4-6\n6-10\n10+"}



How many hours of sleep do you get per night on average?
{"type":"radio","name":"__generic14","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Less than 4\n5-6\n6-7\n8-9"}



How many days per week do you exercise for 30+ minutes?
{"type":"radio","name":"__generic15","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"I don't exercise regularly\n1-2\n3-4\n5+"}



On a scale of 1 to 10 how would you rate the quality of your life in the last 3 months?
1 being low and 10 being high. In terms of your happiness, health, wealth, relationships, and personal growth...
{"type":"radio","name":"__generic16","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}



What would make this coaching experience 10x the value of your time and money?
{"type":"textarea","name":"__generic17","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Your answer"}