Body and Mind Solutions: Life Coaching Questions

Use this form to contact us to set up an appointment for life coaching.

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the Body and Mind
Solution's Feelings
Word Chart.
Created with
Stanford mental
health professionals!

What specific areas apply to your interest in coaching?

I want more time in my life for the things I enjoy

I want more balance between my home, work, and play

Life Coaching Questionnaire

Your Full Name:

Your E-mail Address:

Street Address

City, State, Zip

Home Phone Number:

Cell Phone Number:

Purpose of Inquiry:

I am in the midst of a transition

I want to grow my business

I want to make and keep more money

I'm thinking about changing careers

I'm doing well, I just want a competitive edge

I want to be more efficient and organized

I want more energy

I want to communicate more effectively

I want closer relationships

I want fewer problems in my life

I want to focus on a great idea I have

Which best describes your interest in coaching?

I am actively looking for a coach

I am considering working with a coach

Additional comments: