First Name
Last Name
Email
*
Phone
Business/Organization Name
Website
1 of 18
I know exactly who I want to be and what I stand for each day.
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Yes
No
I set clear goals and priorities that guide my actions.
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Yes
No
I regularly reflect on whether my actions align with my values and mission.
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Yes
No
I consistently have the mental and physical energy needed to perform at my best.
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Yes
No
I take care of my body through proper sleep, nutrition, and exercise routines.
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Yes
No
I manage stress effectively and maintain a positive emotional state.
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Yes
No
I feel a deep sense of purpose and urgency in achieving my goals.
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Yes
No
I hold myself to high standards, even when no one is watching.
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Yes
No
I stay motivated because I clearly understand why my work matters to others and to me.
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Yes
No
10 of 18
I focus on what matters most and avoid unnecessary distractions.
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Yes
No
I consistently complete my highest-priority tasks each day.
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Yes
No
I proactively block time for deep, focused work without interruptions.
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Yes
No
I positively influence those around me through my communication and actions.
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Yes
No
I inspire others to believe in themselves and reach for higher standards.
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Yes
No
I actively build trust and strong relationships by being authentic and supportive.
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Yes
No
I regularly take bold actions even when they feel uncomfortable.
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Yes
No
I voice my ideas, opinions, and needs, even when facing resistance.
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Yes
No
I push myself to tackle new challenges that stretch my capabilities.
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Yes
No
My current level of interest in High-Performance Coaching.
*
Very Interested
Interested
Unsure
Not Interested