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Professional Coaching
North America
1-646-939-9339
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Awakening • INSPIRing • Enlightening
My Story
Coaching Services
How it Works
Who I Coach
Blog
Let's Chat!
Please fill out the life questionnaire below:
LIFE QUESTIONNAIRE
Life Questionnaire
Name
*
First Name
Last Name
Phone
(###)
###
####
Email Address
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
How did you hear about Coach Tobias?
Describe your living situation
Describe your significant other (if applicable)
Describe your parents and your current relationship to them
Were you adopted?
Yes
No
Do you have siblings?
Yes
No
Do you have children?
Yes
No
Have you ever been hospitalized for medical or emotional reasons?
Yes
No
No Have you ever been in a severely traumatizing event? (Natural disaster, War, Violent Crime, Accident, etc)
Yes
No
Are you currently seeing a therapist?
Yes
No
No Are you currently under any form of medical care?
Yes
No
What do you consider your strengths?
What do you consider your weaknesses?
Survey
You are satisfied with your Physical Body
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Emotional well being
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Mental well being
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Spiritual well being
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied Financially
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Family Relationships
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Friendships
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Romantic Relationships
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Career
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Home Environment
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Work Environment
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your Service to Others
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your level of Joy
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You suffer from Guilt
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
You are satisfied with your level of Success
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
What is working about your life?
What would your life look like if it were your dream life?
What is stopping you from doing or achieving what you are committed to?
What is (are) the biggest challenge(s) in your life?
What is (are) the biggest challenge(s) in your life?
Thank you!
