1. I am someone who is curious about how to explore changes to further myself.

2. I have some specific goals for myself that I am currently motivated to reach.

3. People have told me that a strength I have is knowing when to get assistance from others which can help me to perform better.

4. I tend to take feedback in a non-defensive manner in which I truly consider what people tell me..

5. I think that I have strengths and capabilities which I have not yet truly tapped.

6. I am open to considering new perspectives and ideas for various aspects of my life.

7. Lifelong learning, education, and self improvement are among my greatest values.

8. People have told me that I am solutions-oriented and someone who takes action to achieve change.

9. I would like to become more focused, efficient, or clear in the process of goal attainment.

10. There are important goals in my life that I have not yet reached but would like to begin the process of meeting them starting today.

11. I believe that I could further myself by making some changes. I am not sure what my goals are or what changes I want to make in my life but I know that I want to find out.

12. I am willing to take the primary responsibility for doing the necessary action steps that will help me to move ahead.

13. I do not have difficulty with meeting deadlines, generating results, or sticking with a timetable for goal accomplishment.

14. If asked to write down the top 3 major changes I would like to make in my life over the next 3 months, I would have no problem answering.

15. I can clearly see and articulate how working with a professional coach would benefit my life right now.

16. Someone has recommended coaching to me or told me about coaching and I have thought, “what an excellent idea!”

17. I have a strong desire to make my life more focused, simple, clear, or satisfying.

18. I believe that working with someone who has a more objective view can significantly help me to see things in my life differently.

19. If someone were to provide me with constructive criticism, I would carefully consider what they had to say, ask others for feedback as well, and then take action.

20. I am ready right now to dedicate the time, energy, and finances to make real changes in my life that can last for a long time.

21. I am very interested in figuring out how I have created obstacles to my own success.

22. In planning to hire a coach, I intend to interview a couple coaches and ask specific questions to make sure that they are a good match for me and can guide me by the process of coaching.

23. I would like to have someone help me to recognize what is working well in my life and how I can capitalize on my strengths to figure out how to create and reach my goals.

24. I am someone who values diversity of perspectives and opinions.

25. I do not have a psychological disorder (e.g., depression, anxiety, eating disorder) that is unstable or untreated.

26. I can commit to being on time and prepared for my coaching sessions even if I have a lot of other things going on in my life.

27. I recognize that coaching requires a financial investment and I believe that it is worth it.

28. I have no reason to believe that therapy would be a better resource for me than coaching right now OR I have received an evaluation by a psychologist who stated that coaching is the more appropriate option for me.

29. If, while working with a coach, my coach gave me specific homework assignments or action steps to do, I am confident that I would work hard to complete them between sessions.

30. I believe that my natural support systems (family, friends, partners) are too close to my issues to provide objective coaching, so a professional coach could add significant value.

31. I am worried that I may never discover my true potential if I do not do some work on that discovery process.

32. I have attempted to make changes or embark on the process of meeting my largest goals on my own, but have not been entirely successful. I think that a partner who will assist me would benefit me more than a consultant who would give me specific advice.

33. I understand that a coach will help me to recognize solutions, strengths, and opportunities, but will not do things for me or tell me exactly what to do in every scenario I raise.

34. I am not looking to reduce or solve a problem, such as an anxiety disorder, instead, I am interested in promoting growth and development right now.

35. I know the difference between therapy, consulting, and coaching and I believe that coaching would best meet my needs right now.