Breakthrough Call Questionnaire

What You’ll Do Before the Call

Complete the following questions so I can be better prepared for our time together in the Strategy Call.

Don't worry about "perfectly" answering them. We'll be going into detail in our call. My goal is to be able to serve you at the highest level in where you are right now.

What Happens During the Call

We'll have a purposeful & powerful conversation about what your dreams, goals, and challenges. I'll ask some questions to clarify and bring clarity to you. My goal also is for you to come away from this session with some impact that will move you along in your journey.

What Happens After the Call

I am here to serve. This conversation also is an opportunity to see how I work as a Psychologist & Coach. We'll also talk about what that would look like to continue to work together and options for moving forward. I believe the right things happen at the right time.

Fill out the Questionnaire below and submit answers as you go by pushing the blue button on the bottom right corner
You will then be taken to my calendar to schedule your Strategy Call.

Thank you for taking the time to fill out this Questionnaire for our upcoming Coaching Strategy Session. This helps give me information in advance to better structure our time so that you can get the most out of it!

These questions will take you about 10 minutes to complete.

First Name

Last Name

Email *

Marital Status

Please complete the follow questions with ratings using the following 1-10 scale.

10= Yes I feel that way all the time!

1= No I don't feel that way ever.

Do you feel you are clear about who you are, your purpose, and the direction you want to go in life?

Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?

Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities?

Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals?

Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?

What do you do for a living & why did you choose that career?

What are your top 3 goals you are striving to achieve right now?

When you feel like your most successful and happy self, what makes you feel that way?

What major stressors or challenges are you struggling with right now?

What would your dream life look like if you could wave a wand and make it happen?

What else has prevented you from having that dream life?

What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?

What 3 big changes would you like to make in your life in the next 12 months?

What are you most proud of and excited about in your life?

What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident, and successful?

What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently?

What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?

When do you struggle to be fully present in your day or in any of your relationships?

How purposeful do you feel in living each day, and how would you describe your purpose?

If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

Why do you feel you could be a great coaching client if we worked together?

Why would you like to work with Dr Sheri as a coach?