Coaching Breakthrough Questionnaire Form

As your coach, it is important for me to understand who you are, what you value and how you approach life. These "pondering" type questions are designed to allow you to pause and think about who you are becoming and what you long to accomplish with your life. Please set some time aside to consider these questions before your first session. You can return this form back to me using the online form by hitting submit at the end of this form or by mail at:

Kim Fletcher - Creative Life Navigation
5719 Crown Terrace
Hickory, NC 28601

Please Enter Your Name
Mailing Address
City, St Zip
Primary Phone
Secondary/Cell Phone
Birthday
Email Address

All client data is highly confidential and will not be shared unless by client request.

I am passionate about: (list as many things as you like)

Your significant life achievements: (list as many things as you like)

Of these life achievements, which are most significant to you?

1. What three things would make you ecstatic if you were able to accomplish them in the next 90 days?

2. What would you like more of in your life? (ex. Money, Time, Creativity, Friends, Energy, Travel, etc.)

3. What could you do to reinvent your daily work life so that you were spending the majority of your time working in your strengths and doing work that you love?

4. What things have gone through your mind since our previous conversation that you would like to be coached around?

5. If you could spend the remaining days of your life doing anything at all and money was no obstacle, what would you do?

6. List 3-5 things that you feel like you are tolerating/putting up with, but would rather not?

7. 90 day goals: Make a list of things that you think you would like to do or bring to completion in the next 90 days. These can be goals, adventures, things you wish to accomplish, people you want to connect with... anything!

8. Life Goals: Begin making a list of life goals that you can see yourself doing and list the year that you feel that you will be doing them. The list can be as long or as short as you like.

9. Please write anything else that you would like me to know that will help me coach you better. Ex. Personality traits, learning style, how you wish to be held accountable, what encourages/motivates you, etc.