Welcome ,
Once you pay for your sessions please take a moment to fill out this questionnaire below and e-mail it back to me. Just copy the below text and paste it into a new message addressed to marshall@yourfalsereality.com
Your answers are strictly confidential and will help create a better better “road map” for our goal setting interview If you have chosen not to retain my services, I support you to complete this questionnaire and keep it for yourself as it presents an opportunity for self-evaluation.
1. What do you hope to achieve by retaining a life coach?
2. What one main belief do you have about yourself that is limiting you from expressing your passions and being greater than you already are?
3. What is your greatest fear?
4. What type of person causes you to be most uncomfortable around? (Please place a number i.e., 1,2,3 by your top three choices.)
Loud, attention seeking types
Rude and Disrespectful
Shy and Quiet
Complainers
Elitists
Perfectionists
Religious Zealots
Condescending / Know it All
Other
5. Do you believe that you are able to care whole-heartedly about another human being? (Y/N)
Please answer the following questions by selecting 1-5. 1=Never 2=Seldom 3= Occasionally 4= Often 5= Always
6. Do you have a hard time saying “yes” when you mean “no?”
7. How often are you clear about your intentions with others?
8. How often are you often concerned about the opinions of others?
9. How often are you stressed or angry?
10. How often do you feel that the “real you” is different than the identity of you that shows up in the world?
11. I struggle with pain and regret from the decisions I’ve made in my life.
12. I am deeply concerned about my future.
13. I am preoccupied with thoughts of my past relationships. (Break-ups, divorce, death)
14. I feel that I might be addicted to one or more of the following; (Type Y, N or U for uncertain next to the choice)
Sugar
Coffee
Cigarettes
Drugs
Alcohol
Chocolate
Sex
Search for love / Relationships
Finally, if you have any suggestions or anything that you personally would like to work on please answer below.
Thank you for completing this registration questionnaire. If you have any questions about this questionnaire or the workshop, my experience or qualifications please feel free to contact me 786-290-8004
If you have not yet purchased coaching sessions please do so at the “online payment” page of this site or:
Thank you and congratulations on your commitment for your personal development.