Paul & Layne’s Pre-Coaching Questionnaire Step 1 of 4 25% Please read and understand the following:After Paul & Layne review your questionnaire they will contact you by e-mail to schedule your 30 minute preliminary conversation.The purpose of this conversation is to explore the possibilities and appropriateness of coaching for you with the concerns you have. Layne and Paul’s time is at a premium, so the condition for them offering this much time is that you will make a decision within three days about whether or not you want to move forward with coaching.You have complete choice and whatever you choose is fine with Paul and Layne. If you choose to move forward with coaching you will then have a conversation about the next step and design your coaching program together. And if you decide not to move forward with coaching, you will experience no hard feelings from Layne or Paul and you will part on friendly and respectful terms.Please allow 72 hours before getting a response. This time depends upon Paul and Layne's current schedule. All information is held in the strictest confidence. Name* Phone* Your Time Zone* Pacific Mountain Central Eastern International e-Mail* Your Partner’s Name Your Age Occupation*What is your current occupation or career? Are you retired? Your Past/Present History, Interest and Goals(Please check all that are true for you.)Please check all that are true for you. Improve my relationship with myself Improve my relationship with my mate/significant other Improve my professional/work relationships Learn how to consciously create my relationships Attract a man/woman into my life Let go of a relationship Get help with a breakup or divorce Improve my communication Learn to handle upsets better Gain more self-esteem Gain more confidence Improve my sex life Increase my motivation Feel less stressed Feel more relaxed and at ease Create more success in life Learn to deal with my feelings better Learn to deal with other peoples’ feelings better Get out of emotional pain Do you presently have a life partner? Yes No Current RealityAre your romantic relationships as satisfying as you want? Yes No Are your family relationships as satisfying as you want? Yes No Are your friendships as fulfilling as you want? Yes No Are your professional relationships encouraging & supportive? Yes No Do you have children? Yes No Do you have the employment you want? Yes No Do you have the income/money you want? Yes No Are you regularly engaged in activities you enjoy? Yes No Do you have the health & wellness you want? Yes No Are you part of a supportive community? Yes No Are you learning & growing the way you want? Yes No Are you where you want to be spiritually? Yes No Have you had a personal or professional coach before? Yes No If so, when and for what?Was it a successful experience for you? Please explain...Why are you considering coaching at this time?Is the situation you want support with a new or longstanding situation? Please explain..I am interested in coaching just for myself. Yes No Maybe I am interested in coaching for my romantic relationship/marriage. Yes No Maybe I am interested in coaching for a business or professional relationship. Yes No Maybe On a scale of 1-5 how ready do you feel to make those changes, with 1 being not at all and 5 being 100% ready now? (Less True > More True) 1 2 3 4 5 Are you interested in working with Layne or Paul or both? Layne Paul Both Doesn’t matter How did you hear about us?*If you decide to move forward in coaching with Paul and Layne after yourpreliminary conversation, they will work with you to design a custom coaching program. This will be based on your needs and goals, time availability, your budget and your commitment level. If there are restrictions or important influences in any of these areas, please let Paul and Layne know what they are in the space below. Δ
