Name
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First Name
Last Name
Email
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Phone Number
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WhatsApp
Country
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Preferred method of communication
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Email
Phone
Text
Video Call
Have you worked with a coach before?
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If 'Yes', what was your experience like?
How would you describe your current mindset in challenging or stressful situations?
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Please explain
What are the most frequent negative thoughts or limiting beliefs you experience?
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Please list examples, e.g., "I’m not good enough," "I always fail."
On a scale of 1-10, how confident do you feel in your ability to overcome challenges in life?
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1 - Not confident at all
2
3
4
5
6
7
8
9
10 - Extremely confident
Do you often engage in negative self-talk? If yes, what does it typically sound like?
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Please describe
Are there any recurring fears or doubts that hold you back from taking action in your life?
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Please describe
Why are these goals important to you?
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Please describe why these goals matter and how they will impact your life
What areas of your life would you like to see the most growth and change?
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e.g., career, relationships, personal development, health
How would your life improve if you were to achieve your mindset goals?
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Please explain
On a scale of 1-10, how committed are you to making the necessary mindset shifts to reach your goals?
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1 - Not committed
2
3
4
5
6
7
8
9
10 - Fully committed
What motivates you to want to improve your mindset?
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Please explain your driving motivation
What do you expect from me as your mindset coach?
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Please describe any specific expectations or qualities you're looking for in a coach
What do you hope to achieve from this coaching program?
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Please describe your long-term vision or desired outcome from this coaching experience
How do you typically respond to feedback and accountability?
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How do you learn and grow best?
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If other, please explain:
Are there any additional challenges or issues that you think I should be aware of?
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Please describe anything that may affect your mindset or ability to reach your goals
Are you currently working with a therapist, counselor, or any other mental health professional?
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If yes, is there anything I should be aware of regarding your mental health as we begin this coaching journey?
Please explain, if applicable
Is there anything else you would like to share before we begin?
Please include any additional comments or concerns you may have
Preferred Coaching Schedule:
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Preferred Coaching Session Times:
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Preferred Coaching Platform:
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Date
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MM
DD
YYYY
Signature:
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