Mindset Questionnaire

Mindset Coaching Questionnaire

Answering the questions below is the start of your coaching. It may reveal something you didn't know, a blind spot you didn't realize you had. Take 5 minutes to complete it and begin the coaching process.

General Information

* Indicates required field

Name *

First

Last

Email *

Job Title *

Skill & Capacity

What makes you feel like you're "in the zone"? *

When was the last time you felt that way (either at work or at home)? *

What makes you feel overwhelmed? *

Is there a payoff to doing those things that make you feel overwhelmed? *

Yes No

If so, do you have an idea of what it is? *

Focus & Productivity

What would ideally improve your focus AND peace of mind at work? *

What is the #1 thing that distracts you at work? *

Fitness & Attention

Do you pace yourself by building in regular breaks from work? *

Yes No

Do you regularly take time to step back to define or redefine what needs to be done? *

Yes No

Do you ever feel guilty when you take breaks or leave early? *

Yes No

In general, is there anything you feel guilty about? (please describe if you're willing) *

Do you give others your full presence and attention in meetings and conversations? *

Yes No

If you answered "No" to the last question, what affects your level of attention? *

Training & Development

Which 3 topics below would you be most interested in learning more about? (Pick 3) *

Mindfulness Training (improving attention, being more focused) Stress Reduction (finding an "off" switch, reducing anxiety) Productivity (increasing output, avoiding burnout) Decision-Making (thinking clearly, choosing consciously) Resilience (bouncing back, reacting less) Self-Awareness (situational awareness, greater balance) Creativity (overcoming blocks, thinking insightfully) Leadership Training (communicating effectively, improving EQ)

How interested are you in INDIVIDUALIZED 1-ON-1 PHONE/VIDEO COACHING in the areas you selected above? *

Not Interested Somewhat Interested Very Interested Extremely Interested

How interested are you in ONLINE GROUP COACHING for the areas you selected above? *

Not Interested Somewhat Interested Very Interested Extremely Interested

What difference would consistently showing up at your best make to the outcomes you hope for at work and at home? *

Thank you for taking the time out of your day to complete this survey. Review your answers, and click on the "Submit" button when you're satisfied.

Submit