AKSHAY KAPUR
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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
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Name
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First
Last
Email
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Job Title
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Skill & Capacity
What makes you feel like you're "in the zone"?
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When was the last time you felt that way (either at work or at home)?
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What makes you feel overwhelmed?
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Is there a payoff to doing those things that make you feel overwhelmed?
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Yes
No
If so, do you have an idea of what it is?
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Focus & Productivity
What would ideally improve your focus AND peace of mind at work?
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What is the #1 thing that distracts you at work?
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Fitness & Attention
Do you pace yourself by building in regular breaks from work?
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Yes
No
Do you regularly take time to step back to define or redefine what needs to be done?
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Yes
No
Do you ever feel guilty when you take breaks or leave early?
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Yes
No
In general, is there anything you feel guilty about? (please describe if you're willing)
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Do you give others your full presence and attention in meetings and conversations?
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Yes
No
If you answered "No" to the last question, what affects your level of attention?
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Training & Development
Which 3 topics below would you be most interested in learning more about? (Pick 3)
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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?
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Not Interested
Somewhat Interested
Very Interested
Extremely Interested
How interested are you in ONLINE GROUP COACHING for the areas you selected above?
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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?
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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.
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