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Client Feedback
This survey is to help me gauge how much progress my clients are making.
Step
1
of
3
33%
Name
*
First
Last
What is your profession?
*
Email
*
Location: City, State, Country?
*
What is the date today?
*
MM slash DD slash YYYY
When did the coaching start (approximate date is ok)?
*
MM slash DD slash YYYY
How many sessions have you had so far?
*
1
2
3
4
5
6
7
8
9
10
10+
Please, rate the following aspects of your life from 0 to 10 as you feel right now (10 being perfect)
Physical (Body & Health)
*
0
1
2
3
4
5
6
7
8
9
10
Relationships (Romantic)
*
0
1
2
3
4
5
6
7
8
9
10
Friends
*
0
1
2
3
4
5
6
7
8
9
10
Family
*
0
1
2
3
4
5
6
7
8
9
10
Financial
*
0
1
2
3
4
5
6
7
8
9
10
Hobbies/Fun/Interests
*
0
1
2
3
4
5
6
7
8
9
10
Spiritual
*
0
1
2
3
4
5
6
7
8
9
10
Career/Work/Business
*
0
1
2
3
4
5
6
7
8
9
10
Mindset/Attitude/Mental State
*
0
1
2
3
4
5
6
7
8
9
10
Home & Environment
*
0
1
2
3
4
5
6
7
8
9
10
Contribution/Charity/Community
*
0
1
2
3
4
5
6
7
8
9
10
Which aspects of your life did you want to address when you started the coaching sessions (check as many as applicable)?
*
Physical (Body & Health)
Relationships (Romantic)
Friends
Family
Financial
Hobbies/Fun/Interests
Spiritual
Career/Work/Business
Mindset/Attitude/Mental State
Home & Environment
Contribution/Charity/Community
Other
What changes have you noticed in your feelings and emotions?
What changes have you noticed in your behavior?
What other insights have you gained from our work?
In terms of the goals you had set out for this coaching series, how much progress do you feel you have made on a scale from 0 to 10 so far?
*
0
1
2
3
4
5
6
7
8
9
10
If your have experienced or experiencing positive changes in your life due to our work together, would you care to leave a brief testimonial for my website in the format (my challenge - experience after the work).
Would you prefer to leave your testimonial anonymous: just initials, profession and location?
Make it anonymous
I'm ok to share my name
Δ
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