1:1 Coaching Questionnaire

First Name

Last Name

Email

Phone

Website/URL

Please list your main social media handles

In what City / State / Country do you live?

How do you know about Pauline?

If Other - Please specify.

What is your profession?

Are you happy in your current profession?

Yes

No

What are your Professional Goals?

Do you have a Dream? Would you care to share it?

If Other - Please specify.

What are your darkest fears?

Why would you like to be coached / mentored by Pauline Nguyen?

List any relevant assessments you have recently had that could be provided so that Pauline can understand you better.

How old are you?

How old do you feel?

Have you ever had a coach / mentor before?

Yes

No

Who was your coach / coaches? In what areas were you coached?

In order of importance to you, order the following human needs from 1-6. Significance Certainty Variety Growth Love & Connection Contribution

In order of importance, which best describes you? Order the following traits from 1-4. Determined and Driven, Spontaneous and Carefree, Skeptical and Analytical, Always put the needs of others first

What do you want to experience in LIFE?

How do you want to GROW?

What do you want to CONTRIBUTE?

Who is the person you dream of becoming? What does this new version of feel like?

What are your greatest desires?

What do you think is holding you back?

Do you experience pain, dis-ease or disease?

Yes

No

Is it emotional, mental, physical or spiritual?

Tell me more about your pain.

What is your reason for wanting to work with Pauline and joining this program?

If other, please explain.

	USD	USD$
	AUD	AUD$

Please tell me more about you

NEWSLETTER

SUBSCRIBE TO WEEKLY INSPIRATION HITS AND LATEST UPDATES