Arlene J. Placer-Cosgrove
C.C.U. & I.C.F.
Personal Coach

Cheetahs...one of the fastest animals on land. Strong, slim, supple, beautiful, determined.
Just as we humans are.

Client Questionnaire
Complimentary Session Form

Instructions:

Either

1. Open the Microsoft Word Version
2. Save Questionnaire on your computer
3. Email Questionnaire to arlenejp@lifecoachmaster.com

Or

1. Cut and paste the following Questionnaire into the body of an email
2. Fill it out
3. Email Questionnaire to arlenejp@lifecoachmaster.com

COMPLIMENTARY SESSION FORM

Arlene Placer/Cosgrove
8 Elm Place
Red Bank N.J. 07701
732-747-8896
arlenejp@lifecoachmaster.com
http://www.Lifecoachmaster.com

Date:_____________________________________________________

Age:______________________________________________________

My name is ________________________________________________

Marital Status:______________________________________________

Are you happy with your married life? Yes ___ No ___

If not and you had your way, what would you change about it?

__________________________________________________________

What is keeping you from making the change?

__________________________________________________________

Job Status:_________________________________________________

Are you happy with your job? Yes ___ No ___

If not and you had your way, what would you change about it?

__________________________________________________________

What is keeping you from making the change?

__________________________________________________________

What are the top 3 things you wish to accomplish in the next 30-90 days?
(please be very specific i.e., "being happy" is not specific)

1. ________________________________________________________

2. ________________________________________________________

3. ________________________________________________________

Out of the top 3 things above, which one seems to be the hardest to do?

1.________________________________________________________

2. ________________________________________________________

3. ________________________________________________________

If you could make it easy for yourself, what would you do and how would it make you feel?

__________________________________________________________

__________________________________________________________

__________________________________________________________

Are you making yourself your first priority? Yes ___ No ___

If not explain why not and what you can do to change that.

__________________________________________________________

__________________________________________________________

__________________________________________________________

What do YOU do for FUN and LAUGHTER?

__________________________________________________________

__________________________________________________________

__________________________________________________________

If money were no object where in the world would you go and why?

__________________________________________________________

__________________________________________________________

__________________________________________________________

Would you like to tornado chase with me? Why not?

__________________________________________________________

__________________________________________________________

__________________________________________________________

Explain your understanding of Coaching.

__________________________________________________________

__________________________________________________________

__________________________________________________________

What do you hope to gain from working with a coach?

__________________________________________________________

__________________________________________________________

__________________________________________________________

Email this questionnaire to me at arlenejp@lifecoachmaster.com and we can begin the process of reaching your goals.