Client Discovery!

Please spend at least 15 minutes before our conversation to answer the following questions. This will get the coaching process going before we even speak, and will provide some clarity, and a base from which to explore whether and how coaching can be useful at this stage of your life.

Note: You may find some of these questions ask the same thing in a different way. If you have trouble with any of these questions, that's okay. Fill in what you can. Part of this process is to help you get clear on your own path forward.

  1. For each of the following areas – how would you rate your life out of 10, 10 being you can’t imagine it to be any better.










  2. What is one goal you would like to achieve in the next six months that will make a BIG difference to your life?

  3. If you could have MORE of one thing in your life right now, what would it be?

  4. What are the three biggest things you are tolerating or putting up with in your life?

Toleration 1:

Toleration 2:

Toleration 3:

  1. If you could change one thing in your life, what would it be?

  2. Out of everything you’ve done, or who you are, what would you most like to be acknowledged for:

  3. To increase your enjoyment of life, what are the three key areas for you to focus on for your own personal development?

Area 1:

Area 2:

Area 3:

  1. Please write down one thing you would like, but are not sure if or how you can have it.

  2. Assuming all human beings have some way of sabotaging their life, or holding themselves back, what would be your favourite way? (You might like to rank your top five in order from 1 – most effective to 5 – least effective.)



    Following secondary goals that won't ulitimately make me happy

    Being indecisive

    Not saying “No”

    Being Arrogant/Right

    Not Saying “Yes”

    Going it Alone

    Controlling Life/People

    Not always telling the absolute truth

  3. If you were to work with a coach, speaking to him/her once a week or month, what would you most likely get from the relationship that might have been missing over the past few months or years? Please rank the top three.





    Sounding Board





  4. How coachable do you suspect you are where being coachable means that you are open to input and feedback; comfortable in partnership; and ready to make changes?

Highly ____ Reasonably ____ I'm trouble _____

  1. On a scale of 1 to 10 (10 being highest) how committed are you to making a change in your life? ________

  2. By when do you want it? ________

  3. On a scale of 1 to 10, how committed are you to getting support in making that change? ________

  4. What day and time would you like to talk to determine whether coaching is right for you and, if so, whether it would be appropriate for us to work together?

Thank You,

Now please send your form to me at

David R. Herz

(203) 517-0518