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Complimentary Life Assessment

Would you like to like to get a better idea of what we focus on in a coaching session? I invite you to fill out this short life assessment. Please take your time as your responses will be a true indication of what areas in your life you would like to change or to focus on.

For taking the time to complete and submit this questionnaire, I am happy to offer you a free consultation.

1. How would you rate the following aspects of your life out of 10?

Health -

Happiness -

Finances -

Career -

Family -

Spirituality -

Friends -

Significant Other -

2. Given these scores, which areas would you like to focus on in the next 6 months?

3. What is your favorite way of "holding you back"?

Fear -

Procrastination -

Stubborn -

Being Controlling -

Being Timid -

Other - (please explain)

4. If you had a coach, what do you think would be the most valuable to you?

Sounding Board -

Accountability -

Validation -

Support -

Inspriration -

Clarity -

Ideas -

Other - (please explain)

5. What are three specific things that you would like to change about your life in the next 3 - 6 months? These can be personal and/or business related.

6. How will your life be impacted when you have these wants and desires fulfilled? How will you feel when you have manifested your desires?

7. What has kept you from already making these changes?

8. What will you miss out on if in a year from now nothing has changed? How will you feel if nothing has changed in a year from now?

9. Where did you hear about Life Is What You Make It and/or Deb Raven?
    Referral
    Workshop
    Yellow Page Ad
    Internet Search
    Other

To receive your free consultation, the following information is required:

Name:

Email:

Phone number:
and best time to call:

Questions / Comments:

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