AEXHPC Application

Your First Name*

Your Last Name*

Phone Number*

Your Best Email*

Address*

City, State Zip*

Occupation*

Skype ID*

Date of Birth*

Gender*

Marriage Status*

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

Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest):

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?*

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?*

Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?*

Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?*

Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?*

General Questions:

1. What do you do for a living, and why did you choose that career?*

2. What are your top 3 goals you are striving to achieve right now?*

3. What major stressors or challenges are you struggling with right now?*

4. When you feel like your most successful and happy self, what makes you feel that way?*

5. What would your dream life look like if you could wave a wand and make it happen?*

6. What else has prevented you from having that dream life?*

7. What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?*

8. What 3 big changes would you like to make in your life in the next 12 months?*

9. What are you most proud of and excited about in your life?*

High Performance Questions:

1. What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?*

2. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?*

3. What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently?*

4. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?*

5. When do you struggle to be fully present in your day or in any of your relationships?*

6. How purposeful do you feel in living each day, and how would you describe your purpose?*

7. Why would you like to work with a high performance coach?*

8. Why do you feel you could be a great student or coaching client if we worked together?*

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