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Life Coaching Questionnaire

The definition of thinking out of the box “ Thinking that frees itself of reflexive obedience to familiar signals”. “The “box” is the result of programming and conditioning self-created in adulthood”.
Dr. David Krueger, M.D.

PLEASE NOTE: Please answer only yes or no to each question. If you think your answer is mostly no answer no if it is mostly yes, answer yes… Thank You

QUESTIONNAIRE

Full Name *
Email *
City
Home Phone
When given a compliment do you Shy away, deflect or “deny” it? i.e. “Oh no I don’t…” *
Yes
No
Do you exercise less than 3 times per week? (At least 1 hour continuous exercise time) *
Yes
No
Do you find yourself skipping meals throughout the day? *
Yes
No
Do you get uncomfortable and frustrated doing the same things and getting the same limited results? *
Yes
No
Do you deny your wants or needs to avoid conflict, to please others or to take care of others? *
Yes
No
When you are being confronted or confronting someone, do you have a hard time expressing your emotions? *
Yes
No
Are you easily distracted or find it difficult to focus at work or at home? *
Yes
No
Do you worry about future events that may or may not happen? *
Yes
No
Are you usually late for meetings or social gatherings? Are you usually late for meetings or social gatherings? *
Yes
No
Do you do anything to nurture yourself and reduce stress? *
Yes
No
Do you have a clear internal ideal of who and what you want to be? *
Yes
No
Do you feel “less than” rather than “equal to” your partner, spouse or friends? *
Yes
No