Welcome to our Life, Health, and Mindset Transformation Questionnaire! Your journey towards positive change starts here. We are excited that you have decided to take a few moments to share insights about your current lifestyle, health goals and mindset transformation. Your responses will help us tailor a personalized transformation plan to support you on this empowering journey  as well as exploring and understanding your childhood experiences. For here is where the programming begins.  

Note: We understand our questionnaire may be lengthy, but must be completed thoroughly. For our mission is to nurture your "WHOLE-SELF," for balance and sustainable growth and transformation.

Deciding to do the work is the first step towards "TRANSFORMATION."


Part 1: This questionnaire aims to gather essential information about your clients and their expectations, providing a foundation for effective coaching. 

1: Introduction:

• Name:

• Age:

• Gender:

• Occupation:

• Briefly describe your current life situation.

• On a scale of 1 to 10, how satisfied are you with your life right now?

• What areas of your life do you feel are thriving, and which ones do you believe need improvement?

2. Goals and Aspirations:

• What specific goals or changes would you like to achieve through life and mindset coaching?

• Are there any obstacles or challenges you currently face that hinder your personal or professional growth?

3. Mindset Assessment:

• Describe your current mindset in approaching challenges and opportunities.

• How do you handle setbacks or failures?

4. Self-Discovery:

• What are your core values and beliefs?

• In what ways do you envision personal growth and self-discovery benefiting your life?

5. Coaching Preferences:

• What coaching style resonates with you?

• Are there specific areas or themes you’d like to focus on during our coaching sessions?

6. Communication and Commitment:

• How would you prefer communication during coaching sessions (e.g., video calls, phone calls, messaging)?

• On a scale of 1-10 how committed are you to doing the work, to actively participating in the coaching process and implementing recommended strategies? Note: This takes commitment, dedication, and time.

7. Previous Coaching Experience:

• Have you worked with a life or mindset coach before? If yes, what was your experience?

8. Availability:

• What days and times are generally most convenient for coaching sessions?

9. Do you have a positive support system to encourage you and walk with you on this journey? If so who? and what is your relationship with them?

10. Additional Information:


Part 2:  This questionnaire aims to create a foundation for exploring and understanding the client’s childhood experiences, fostering a supportive environment for growth and healing in the coaching process. 

1. Childhood Memories:

• Share a positive memory from your childhood that still brings you joy.

• Reflect on a challenging experience from your childhood and how it may have shaped you.

2. Family Dynamics:

• Describe your relationship with your family during your childhood.

• How did your family environment influence your beliefs and values?

3. Significant Influences:

• Identify key figures (parents, caregivers, siblings) who played a significant role in your childhood.

• How did these influences impact your development and perspective?

4. Challenges Faced:

• Were there any specific challenges or hardships you faced during your childhood?

• How did you cope with difficult situations at that time?

5. Educational Experiences:

• Share your experiences with education during childhood.

• Did any particular teachers or school activities leave a lasting impact on you?

6. Impact on Current Life:

• In what ways do you believe your childhood experiences continue to influence your present life?

• Are there patterns or behaviors that you recognize from your childhood affecting your current mindset?

7. Healing and Growth:

• Reflect on any efforts you’ve made towards healing from challenging childhood experiences.

• What steps do you believe would contribute to your ongoing personal growth and resilience?

8. Goals and Intentions:

• Are there specific goals related to overcoming childhood-related challenges that you’d like to work on in coaching?

• How do you envision a positive transformation in your life based on these experiences?

9. Communication Preferences:

• How comfortable are you discussing childhood experiences, and do you have any preferences for communication during coaching sessions?

10. Please add any and all components that could contribute to a successful renewing of your mind.

11. Any additional information to help us serve you better?


Part 3: This questionnaire aims to create a foundation for your healthcare goals and how to achieve them for your desired transformation.

1. Lifestyle:

• Occupation:

• Daily Schedule (Work hours, sleep hours, etc.):

• Hobbies and Interests:

• Stress Levels (Low, Moderate, High):

2. Physical Health:

• Any existing medical conditions:

• Current medications or supplements:

• Allergies:

• Exercise Routine (frequency, type, duration):

3. Nutrition:

• Dietary Preferences (vegetarian, vegan, etc.):

• Daily Water Intake:

• Any specific dietary restrictions:

4. Sleep:

• Average hours of sleep per night:

• Quality of sleep (restful, restless, etc.):

• Any sleep-related issues (insomnia, snoring, etc.):

5. Mental and Emotional Well-being:

• Current stressors or challenges:

• Coping mechanisms for stress:

• Emotional support system (family, friends, etc.):

6. Goal Setting:

• Short-term and long-term goals:

• Other areas of life you want to improve (career, relationships, personal development, etc.):

7. Mindset and Beliefs:

• Describe your current mindset:

• Limiting beliefs you want to overcome:

• Positive affirmations or practices you follow and are you interested in us sharing affirmations with you?:

8. Previous Coaching or Counseling:

• Any previous experiences with life coaching or counseling:

• What worked well in the past, and what didn’t:

9. Expectations:

• What do you expect to achieve through life coaching:

• How committed are you to making positive changes:

• Any specific challenges you foresee: Remember to assure users that their responses are confidential and will be used solely for the purpose of providing personalized coaching support.

10. Weight Goals:

. How much weight would you like to lose as a part of your transformation journey:

. What motivates you to pursue this weight loss goal: PLEASE SHARE YOUR REASON BEHIND YOUR DESIRED TRANSFORMATION:

. Do you have a support system? If so who?

11. Any additional information to help us serve you better?