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Questionnaire Form
DREAMS DETERMINE DESTINY QUESTIONNAIRE 3D
*Please type responses to all questions and e-mail back to codyrdover@gmail.com. All Information is Private & Confidential.
Name
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First
Email
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Phone Number
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Goals
What are the 3 BIGGEST goals you want to achieve over the next 12 months?
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Explain to me your vision ONE year from now. BE SPECIFIC as possible? (All Areas) Money, relationships, Business, spirituality etc.
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PERSONAL HISTORY
What would you say have been your three greatest accomplishments in your life to date?
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What is the hardest thing you have ever had to overcome?
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Hows your relationship with yourself?
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Whose love did you crave love from most, your mother or father? And who did you have to be for that person?
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YOUR LIFE
Who are the key people in your life right now?
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How much of your life do you spend, trying to feel in control?
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On a scale of 1 – 10, 10 = HIGH, provide a number that represents your current level/degree of stress:
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What are your primary stressors? Be Specific
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Tell me about your pattern when you get stressed or overwhelmed? Give example.
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COACHING YOU
What do you hope to address with your coaching & accountability sessions?
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What would you expect or like your Coach to do if you get behind on your goals?
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Do you get motivated by someone telling you what to do or motivated by inspiration?
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Explain to me your WHY for doing this?
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If you could do anything for the rest of your life, what would you be doing?
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Life Visions
How important is it for you to Focus & grow right now?
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If you could be in the perfect position 6 months from now, what would that look and feel like?
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What would you like to contribute to the world?
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What is a dream or goal you want but have heaps of resistance for?
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What’s your ultimate relationship vision?
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On a scale of 1 to 10 (10= HIGH), rate the quality of your life today:
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