Life Balance Questionnaire

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Which of the following best describes where you are in your life right now?

I feel lost or disconnected and need help finding clarity in my life’s direction. I have a specific area of my life that I want to work on (e.g., career, relationships, health). I feel like I need emotional support and a space to heal. I want to focus on building my self-esteem and confidence. I feel stable, but I want to grow to my next level. I am ready to take inspired action and make big life changes.

What area of your life would you most like to focus on with a coach?

Career and professional growth Relationships (romantic, friendships, family) Personal growth (self-worth, mindset, spirituality) Overcoming emotional blocks and past trauma Health and wellness Confidence and self-expression Other

Other

How would you describe your current emotional state?

Overwhelmed, anxious, or unsure Stuck or lacking clarity Calm but feeling like I’m not growing Generally positive, but I want to work on specific issues Motivated and eager to work on my goals Emotionally drained and looking for healing

Are you looking for a coaching program that provides practical, step-by-step strategies, or one that helps you explore and discover your deeper self?

I need a structured, action-oriented plan to achieve specific goals. I want a program that helps me explore my inner self and gain clarity. I want a balanced approach that combines both practical strategies and personal discovery.

Which of the following coaching programs are you most interested in?

Clarity and Life Direction Coaching: Helping me get clear on my life’s purpose and direction. Confidence and Empowerment Coaching: Building my self-esteem and self-worth, and overcoming limiting beliefs. Mindset and Healing Coaching: Overcoming past trauma, emotional blocks, and shifting limiting mindset patterns. Career and Life Transformation Coaching: Practical steps and strategies to achieve career growth and personal transformation. Holistic Life Coaching: Focusing on personal development through a mind-body-spirit approach. Emotional Resilience Coaching: Strengthening my emotional resilience and coping with life’s challenges.

What is your biggest priority right now in terms of personal development?

Gaining clarity on my life’s purpose or next steps Overcoming emotional or mindset blocks Improving my self-esteem and confidence Career or business advancement Healing and recovering from past trauma or struggles Creating a balanced and fulfilling life with wellness practices

Are you looking for a coaching plan that offers specific tools and resources (e.g., worksheets, exercises, action steps), or one that focuses more on providing emotional and mental support?

I want a plan that gives me practical tools, exercises, and action steps to implement. I need emotional and mental support to work through my challenges. I’m interested in both — a mix of support and actionable steps for transformation.

How comfortable are you with making changes in your life right now?

I am ready to make significant changes and take bold steps. I’m ready, but I need guidance on how to take the first steps. I’m open to small, gradual changes. I’m not sure if I’m ready yet, but I want to explore my options.

Do you have a specific vision of what success would look like for you after coaching?

Yes, I have a clear vision of my desired outcomes and need a plan to get there. Yes, but I’m not sure how to make it a reality. No, I’m still figuring out what I really want. No, I’m open to discovering what success could look like for me.

Are you specifically interested in a coaching program that includes mindset or emotional healing?

Yes, I need emotional healing and mindset work to move forward. Yes, but I also want practical tools for personal or career growth. No, I’m looking for practical, goal-driven support. Not sure – I’m open to both approaches.

About Us

Welcome to this transformative and safe haven of wellness, where we offer personalized coaching services designed to help you achieve your unique goals and unlock your limitless potential.

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(630) 344-9516

stacey@thepassionatelifecoach.com