"The Dr. E Show" Podcast
Guest Appearances & Interviews w/ Dr. Edith
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Questionnaire For Your Coaching Strategy Session
Instructions
Thank you for applying for our coaching session. Please answer the questions below to the best of your ability. This helps us to customize our session and get the most out of our time together. I look forward to working with you!
Which programs are you interested in?
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*1-on-1* Private Coaching
Group coaching program
SuperWellness
Consciousness Training
Luminous Kids & Parents Coaching
*
Indicates required field
Name
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First
Last
Gender
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Male
Female
Other (Transgender)
Marriage Status
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Married /Domestic Partner
Single
Divorced
Other
Email
*
Phone Number
*
Address
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Line 1
Line 2
City
State
Zip Code
Country
Occupation
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Date Of Birth
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Please briefly describe how you found out about my offerings and why you would like a Strategy Session with me
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Please rate yourself in the following areas of your life on a Scale of 1 (lowest) to 10 (highest)
​Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?
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1 (lowest) to 10 (highest)
Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?
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1 (lowest) to 10 (highest)
Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?
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1 (lowest) to 10 (highest)
Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?
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1 (lowest) to 10 (highest)
Influence & People Skills: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals & dreams?
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1 (lowest) to 10 (highest)
What do you do for a living and why did you choose your career?
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What major stressors or challenges are you struggling with right now?
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What would your dream life look like if you could wave a magic wand and make it happen?
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What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?
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What are you most proud of or excited about in your life right now?
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What are your top 3 goals/visions that you most want to achieve right now?
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When you feel like your most successful and happy self, what makes you feel that way?
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What else has prevented you from having the life of your dreams?
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What 3 big changes would you like to make in your life in the next 12 months?
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Why would you like to work with me as your coach?
*
Submit to Dr. E & Schedule my Strategy Session!
"The Dr. E Show" Podcast
Guest Appearances & Interviews w/ Dr. Edith
Book
About
Work with Dr. E
Weekly Reset
SuperWellness - Total Human Upgrade
Inner Training for Freedom Lovers
Consciousness Training
Luminous Kids & Family Coaching
Private Coaching
Online Courses
Videos
Contact
