Name

First Name

Last Name

I recognize the value of coaching and see it as an investment in my own growth and happiness.

1

2

3

4

5

I am willing and able to pay for this, and to handle my coaching fees responsibly.

1

2

3

4

5

I can be relied upon to set up systems to be on time for coaching calls.

1

2

3

4

5

I recognize that there is value in having a partner that holds a vision for me of my greatest potential and who is working to help me function to my best ability.

1

2

3

4

5

I am eager to take the actions necessary to accomplish my dreams and change patterns that do not serve me.

1

2

3

4

5

I know that my own answers are within me. I believe that through guidance, feedback, and my own sense of right action I can discover those answers.

1

2

3

4

5

I am willing to try on new perspectives that may be different from those I currently hold.

1

2

3

4

5

I know that life and self-discovery can be fun and satisfying. Self-awareness and fulfilling my life purpose are very important to me.

1

2

3

4

5

If I feel I’m not getting what I expect or need from my coach, I will share this as soon as I can and make clear requests to my coach to get what I need.

1

2

3

4

5