Request Trial Coaching Session

The two most important aspects of coaching are that coaching is
1.) completely confidential
2.) totally optional

If you are investigating coaching to see if it could make an impact on your life, then you're in the right place! Please fill in the form to request your trial coaching with Kelly Bliss.

Note: You may want to use this questionnaire on your own to help you prioritize your goals.
I know people who print out the questionnaire once each season to clarify a helpful focus.

Remember, YOU DO NOT NEED TO BE ABLE TO ANSWER THESE QUESTIONS ON YOUR OWN. If you have difficulties answering the questions, then we can think them through together. Sometimes the structure and support of the coaching session is exactly what helps you focus and learn more about yourself.

1) With 10 for excellent, and 1 for needs much work, please rate the following areas of your life.

	1	2	3	4	5	6	7	8	9	10
Wellness/Health
Finances
Career/ Business
Community
Relationships and/or Family
Spirituality, Peace, Stress
Organization/Time Management
Learning & Growth

2) Looking back at the scores you gave the above categories, which TWO areas are you interested in improving over the next three months that would make the biggest difference to your life?

Wellness/ Health	Finances
Career/ Business	Community
Relationships and / or Family	Spirituality, Peace, Stress
Organization/ Time Management	Learning & Growth

3) What goal could you see yourself achieving over the next month that would make a BIG difference to your life?

4) What ONE thing would it be good for you to have more of in your life now?

5) Name three things you are most tolerating or putting up with in your life?

1	2	3

Which is most important to handle first? 1 2 3

6) Please write down one thing you would like to have or achieve, but are not sure if or how you can have it?

7) Which characteristics or behaviors do you see as a problem in your life?

Procrastination	Indecisive	Arrogant/ being right
Acting as Lone Ranger	Tolerating	Not saying "No"
Acting Controlling	Not saying "Yes"	Following secondary goals (i.e., goals that won't ultimately make me happy)
Other:		Not always telling absolute truth

8) If we both agreed coaching is a good move for you right now, what's your best guess at how long it might make sense for us to work together on these goals to really make a good impact?

1 month

3 months

6 months

12 months or more

Required Fields Marked with *

I have read the section how you work with people.* [read more]

I understand that while I may choose to commit to a 3, 6 or 12 month coaching structure, I may still withdraw at any time for any reason.*

If after this complimentary session we decided to work together,
when would you prefer to start?*

	Within the next 10 days
	Within the next 30 days
	Within the next 3 months

Full Name:	*
Company:
Email:	*
Home Phone:	*
Work Phone:	*
Cell Phone:
State:
Comments: