CEO For Life Coaching Discovery Questionnaire

The goal of the questionnaire is to help reach heightened levels of clarity, energy, courage, productivity, and influence on your march to a successful, healthy, and fully charged life. 

It is critical that you fill this out honestly, deeply, critical, and invested. This is about you and your journey to the best version of you. What you put in is what you will get out of this time. Invest in YOU!

Do this in one sitting without distractions. 

Click the button below to start.


Question 1 of 33

Your Full Name?

Question 2 of 33

Phone Number?

Question 3 of 33


Question 4 of 33

City, State, Zip

Question 5 of 33


Question 6 of 33


Question 7 of 33


Question 8 of 33

Date Of Birth

Question 9 of 33






Question 10 of 33

Marriage Status







Question 11 of 33

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

Question 12 of 33

Please Rate Yourself: 

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


Scale from 1 to 10

Question 13 of 33

Please Rate Yourself: 

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


Scale from 1 to 10

Question 14 of 33

Please Rate Yourself: 

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


Scale from 1 to 10

Question 15 of 33

Please Rate Yourself: 

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


Scale from 1 to 10

Question 16 of 33

Please Rate Yourself: 

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


Scale from 1 to 10

Question 17 of 33

What do you do for a living and why did you choose the career?

Question 18 of 33

What are your top three (3) goals you are striving to achieve right now?

Question 19 of 33

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

Question 20 of 33

When you feel like you are most successful and happy self, what makes you feel that way?

Question 21 of 33

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

Question 22 of 33

What has prevented you from having that dream life?

Question 23 of 33

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

Question 24 of 33

What three (3) big changes would you like to make in your life in the next 12 months?

Question 25 of 33

What are you most [proud of and excited about in your life?

Question 26 of 33

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

Question 27 of 33

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

Question 28 of 33

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

Question 29 of 33

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

Question 30 of 33

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

Question 31 of 33

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

Question 32 of 33

Why would you like to work with a High Performance Coach?

Question 33 of 33

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

Confirm and Submit