Thank you for taking the time to complete this brief survey. The purpose of this survey is to gather basic information about your interests, goals, challenges, and life/work balance. Should you choose to engage RElive Coaching services, your answers will clarify how we can best support you in your journey.

Please note that your identity and responses will remain strictly confidential.

As a thank you for your participation, RElive Coaching will offer you a one hour complimentary coaching session*.

* With ALL fields completed, only.

Your Full Name:
Your E-mail address:

Country of Residence:

Your age:


1. Take a moment to reflect on how balanced your life feels to you right now. Choose one response that best describes your feelings:

2. How satisfied are you with the way you organize your time every day?

3. How satisfied are you with your level of control over your work life?

4. How often are you able to enjoy some time for yourself to relax or enjoy a hobby?


5. Choose one career-related goal that best describes your current situation:

6. How satisfied are you with how well you are able to meet a career-related goal?

(Goals can include things such as job hunting, taking a professional development course, sketching out a business idea, finding new professional networks, pursuing job advancement, etc.)

7. Choose up to three personal goals that best describe you:

8. How satisfied are you with how well you are currently able to meet a personal goal?


9. Choose up to three responses that best describe you:

10. Choose up to three responses that tend to cause the most anxiety for you:

RElive Coaching can help ...

11. Life coaching is designed to support and empower you in your life journey. If you had an opportunity to work with a Life Coach, what would be your highest priority? Please choose one:

12. Have you ever worked with a Life Coach?

If yes, what do you feel was the most helpful thing about the experience?


13. Do you have any specific questions or concerns about the life coaching process that we could address for you, either via email or in your complimentary consultation session?