Gwinnett Coaching 












(In addition to this form, please feel free to send a picture or yourself, resume, or any other pertinent information.)



Congratulations on enrolling into a Personal Life Coaching Program. Please take a few minutes to complete this form. All information is confidential and will be used exclusively by me to assist you in creating the results to which you are committed.



Name (Please Print): ____________________________________________________


Address:  _____________________________________________________________


City _________________________ State   ________ Zip code:  __________________


Phone ______________ FAX ______________ Email _________________________


Birth date: _____________________________________________________________


AGE:  ___________


Favorite Hobbies/Interests:








Job?: _____________________________________________________________





Please answer the following questions to assist me

in being the best coach I can be for you.



1.    Describe three items you most want to achieve or accomplish as a result of your coaching. 







2.    Why do you want to achieve these things?








3.    What has prevented you from achieving them in the past?








4.    How will you know when you have achieved your goals?








5.    What is most important to you in life?








6.    What are you most grateful for in life?







7.    What would you say have been your 3 greatest accomplishments to date?








8.    What is the hardest thing in life that you have had to overcome?








9.    Who have been your major role models?









10.  What major transitions have you had in the past couple of years?  Some examples might be ... a change in relationship status, a move, a new job, a new role, entering a new decade, etc. 







11.  On a scale of one to ten, ten being the high, rate the amount of stress in your life right now.








12.  What are your primary stressors?







13.  List 5 things you are tolerating or putting up with in your life at present.  Some examples may be clutter, rude friends, a poor environment, conversations that need closure, etc.









14.  What are the top three major fears in your life?








15.  What motivates you?







16.  What would you like me to do if you get behind on your goals?






17.  What would you like me to do if you miss a coaching session?






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








19.  What do you think is NOT possible to achieve in your lifetime that you wish you could?












...Lynn's background was a great value to the class!

...The class was a great value for the cost.

...I never got sleepy or fidgety during the class! It was a great value.