Mindset Transformation Breakthrough System - Discovery Session Questionnaire

I believe we all have extraordinary abilities to create a more abundant life, that means you, too!

Reach heightened levels of awareness, confidence, focus, wellness, and modeling behavior on your journey to heightened life fulfillment, satisfaction, and joy!

This questionnaire gives me insight into you, your history, your perspective and your goals. It's also the foundation of our upcoming Discovery Session. It's important that we are a great fit to ensure you get the most out of your coaching program.


Instructions:  Please answer the questions to the best of your ability and without judgment so that I can review them before our call.

*If you prefer to fill out your questionnaire via pdf and return via email please contact me at: [email protected]

Click the button below to start.


Question 1 of 31

FULL NAME, D.O.B., EMAIL, PHONE NUMBER (Required for scheduling)

Question 2 of 31

Please briefly explain how you heard about my coaching services and why you would like a Strategy Session with me:

Question 3 of 31

What recurring beliefs, fears or behaviors have limited your confidence, motivation, success and personal exploration?

Question 4 of 31

Who or what events have influenced your negative beliefs, unproductive behaviors or self-doubt?

Question 5 of 31

List 3 adjectives each, both positive and negative, that describe how you see yourself. (Part B) How others see you.

Question 6 of 31

What general wellness habits would you like to start or stop in order to feel mentally, physically and spiritually stronger?

Question 7 of 31

What are your biggest productivity vampires and what major projects or goals are you struggling to complete?

Question 8 of 31

How would your life change if you suddenly won a $500 million jackpot?

Question 9 of 31

What type of influence or mark would you like to make if given the world’s stage?

Question 10 of 31

When do you struggle to be present in your day or during relationships with friends or loved ones?

Question 11 of 31

How often do you connect with other people outside of work and what does that look like?

Question 12 of 31

How would you define your life’s purpose?

Question 13 of 31

How have you followed a life plan that you put in place at a young age, or have you adjusted as life happened to you?

Question 14 of 31

What goal or life aspiration have you ever abandoned or failed at, and why do you believe that happened?

Question 15 of 31

What is an area of your life that you know you need to change, that you think about often, but don’t make any progress?

Question 16 of 31

What 4 life shifts would you like to make in the next 16 months?

Question 17 of 31

What is the topic that you love to do or talk about that lights you up, the one that you feel passionate about?

Question 18 of 31

How do you believe you can improve your social dynamics? More reliable, better listener, more empathy, better boundaries, etc. Please explain.

Question 19 of 31

What is your current career and why did you choose it?

Question 20 of 31

What is the number one life priority you would change today if you could?

Question 21 of 31

What major daily struggles or stressors are you dealing with right now?

Question 22 of 31

What makes you feel most calm, happy and successful?

Life Assessment

Please rate the following areas of your life on a scale from 1 (low) to 10 (high):

Question 24 of 31


Who you feel you are and how you act are in alignment, and you accept your character and behavior as you.


Please rate on a scale from 1 (low) to 10 (high):

Question 25 of 31

You sleep 6 to 8 hours, participate in regular activity, drink at least 64 oz. water, and eat healthy and balanced meals mostly cooked at home?


Please rate on a scale from 1 (low) to 10 (high):

Question 26 of 31


You express who you are and what you believe, and are comfortable establishing boundaries to take care of your needs.


Please rate On a scale from 1 (low) to 10 (high):

Question 27 of 31


You are organized and focused, and good at prioritizing and completing tasks.


Please rate on a scale from 1 (low) to 10 (high):

Question 28 of 31


You think and behave as the person you would like family, friends and colleagues to view you as.


Please rate on a scale from 1 (low) to 10 (high):

Almost Finished...

I bet you found the questions made you think about stuff you don't normally consider.

And that's a great thing, isn't it?

Question 30 of 31

Why would you like to have a mindset transformation coach?

Question 31 of 31

Why do you feel you are ready to be a great coaching client?

Confirm and Submit