Vita Nostra - Coaching

Coaching Questionnaire

Please type responses to all questions and submit. All information is private and confidential.

First Name
Middle Initial
Last Name

What are the three specific outcomes you want to achieve over the next three months?

What is the biggest change you want to make in your life over the next three years?

What would you say have been your three greatest accomplishments in your life so far?

What is the hardest thing you have overcome in your life to date?

What major transitions have you had in the past two years? (e.g. entering or approaching a new decade of life, new relationship, new job, a new residence, changes in children’s ages/stages of life, separation, divorce, death of a loved one, birth of a child, marriage, etc.)

What are your spiritual or religious beliefs? If any?

Who are the key people in your life and what do they provide for you

Coaching you

What would you expect or like your coach to do if you get behind on your goals?

How will you know when you are receiving value (i.e. your money’s worth) from the coaching process?

What types of approaches discourage you or take away your motivation?

How can your coach best support you in the coaching relationship? Please rank the following in order of what you want most out of our Coaching relationship
(1 = LOW; 10 = HIGH).

Brainstorming Strategies Together
Insight into Who You Are and Your Potential
Support, Encouragement, Validation
Exploring and Removing Blocks and Obstacles to Your Success
Accountability; Checking up on Goals
Working through Self Improvement Programs Together
Suggesting or Designing Action Steps Painting a Vision of What You Can Become or Accomplish
Strategic Planning
Directness: Asking Hard Questions; Challenging You to Move Forward
Your Email