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Last Name
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1. What SCORE out of 10 would you give for how SATISFIED you are with your life overall?
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1 Worst
2
3
4
5
6
7
8
9
10 Best
2. If you were to give a SCORE out of 10 for how much FUN you're having in life:
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1: None
2
3
4
5
6
7
8
9
10 Too much fun!
3. If you were to give a SCORE out of 10 for how HAPPY you are in your current CAREER:
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1 Not at all
2
3
4
5
6
7
8
9
10 Love it!
4. Give a SCORE out of 10 for how overwhelmed, BUSY or stressed you usually feel:
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1 Not at all
2
3
4
5
6
7
8
9
10 Feels Like I am Drowning
5. Deep down, I like myself:
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1 Not at all
2
3
4
5
6
7
8
9
10 I love Me 100%
6. What is your FAVORITE thing in life at the moment? (like best)
7. What could be IMPROVED in your life at the moment? (like least)
8. Here are some ways our coaching clients win by working with Timeless Coaching & Consulting. Please check all of the ones that appeal most to you:
*
Required
For More Meaning/Purpose in Life
For More Fulfillment/Happiness in Life
For More Freedom and/or Inner Peace in Life
To Change or Advance in my Career
To Achieve my Goals Faster/More Easily
To Learn to Trust Myself More/Be My Authentic Self
9. I am ready to take ACTION, and make changes in my environment, habits and life:
*
Yes
Maybe
No
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