Susan Shapiro, Life Coach: Client Application
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How to Get Started

Take advantage of my free introductory session by filling out the questionnaire below. Once submitted, I will contact you via email within 24-48 hours to arrange your introductory phone consultation and begin your life coaching process.

Name:


Occupation:

Phone:
Work Phone:
Cell Phone:
Fax:

Home Address:


Mailing Address (if different):


Email Address:


How many hours per week do you currently spend at work?
20 or less 20-30 30-40 40-50 50-60 60+

What three things do you like about your life?


What three things do you dislike about your life?


What would you say are your three greatest accomplishments to date?


What major transitions have you made in the past 5 years (i.e., moved to
a new town, marriage, divorce, new job, etc.)?


What is the most difficult obstacle you have overcome?


On a scale of 1-10 how much stress do you have in your life? What is the
main area causing you stress (i.e., health related, financial, relationship, etc.)?


What are the main areas of concern that prompted you to seek a life coach
at this time?


What are your primary goals in seeking assistance at this time? What, more
than anything, do you hope to gain from working with the life coach?

Additional comments: