Mental Performance Audit
and Application
First Name
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Last Name
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Email
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Website / Social Media Handle
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Phone
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How well would you rate your productivity and performance over the past 4 weeks on a scale of 1 - 10? (10 being the highest)
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How consistent and high would you rate your energy over the past 4 weeks on a scale of 1 - 10? (10 being the highest)
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How consistent and stable would you rate your emotional stability over the past 4 weeks on a scale of 1 - 10? (10 being the highest)
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How did you discover me?
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Why are you interested in potentially working together?
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If you got what you came for from working together, how would you know?
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What’s your next big dream? What are you looking to achieve next and how do you want to feel whilst achieving that big dream?
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What’s slowing you down or getting in the way of achieving this dream? (Think practically, strategically, emotionally)
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What the biggest psychological, emotional and/or self limiting belief that is currently holding you back? (Which emotions are getting in the way? If there was something you believed about yourself that is the root of the problem, tell us what it is, beginning with the sentence that with “I.)
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What’s missing in your life and how are you keeping it out?
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What are your biggest 3 accomplishments to date and why are you proud of them?
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Paint me a small picture of what your life looks like right now. What do you do? How many hours are you working? On scale of 1 - 10 how fulfilled and satisfied are you with how things are?
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What would make you a great client to work with?
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