Please review and agree to the following Contract:

Full Name
Address
Email (A copy of the Terms and Conditions will be sent to this address.)

For the best results, be sure to fill out this questionnaire before each session.

Email To Send Results
1. What Support Are You Seeking Today? (Check all that apply)
2. What topic from above is most pressing at this moment?
3. Please describe your main concern/question related to this topic.
4. Feel free to add relevant background information.  (If parenting related, please include # of children, gender & age)
5.

What type of Coaching Support Would You Prefer For This Session? (Choose all that apply.)




Please note: Coaching offers a safe place to open emotionally. Naturally, you may choose to use a session to vent or receive emotional support. This type of coaching session is perfectly acceptable, but offers completely different results (an emotional release) rather than a goal-oriented solution.  If you choose Venting and Emotional Support, Susan is less likely to guide you toward a resolution during this type of session.  But, that's okay!  Coaching sessions are about what you need at that moment.  And if you change your mind, before or during the session, that's fine too!

Congratulations! You've Completed Your Coaching Session.

To get the most from each session, use this post-questionnaire form to support your progress. You do not have to use/answer all of the questions, only those that support your progress.

Name Email
1. #1 Takeaway From Today's Session:
2. Additional Takeaways From This Session (If Applicable):
3. Current steps/plan to reach current desired goal/outcome:
4. Observations or things to pay attention to at this time:
5. Questions/Notes I have:
6. What was the most helpful insight from today's session:
7. What was the least helpful insight from today's session:
8. Questions or Notes I have for the next session:
9. I am satisfied with today's session:
10. Please provide more insight into your response above.

Use these notes to serve you as needed.

Name Email
1. Emotions Before Session:
2. Emotions During the Session:
3. Emotions After the Session:
4. What Is Behind These Emotions (If Discovered/Determined):
5. What Techniques Will I Try to Support These Emotions, Break the Anxiety or Negative Thought Pattern (if any) and Move Toward Positive Thoughts and Actions?
6. Goal #1:
7. First Steps I'm Taking To Reach This Goal:
8. Goal #2:
9. First Steps I'm Taking To Reach This Goal:
10. Notes/Observations:
11. Resources That Will Help Support My Goals:
12. Suggestions/Topics/Ideas:
13. Questions/Notes/Comments for Next Session:

Use these notes to serve you as needed.

Name Email
1. Notes to Remember:
2. Notes to Remember:
3. Observations:
4. Observations:
5. Concerns:
6. Suggestions/Topics/Ideas:
7. Goals I'd like to Set:
8. Goals I'd like to Set:
9. Resources I'd Like to Find or Learn More About:
10. Additional:

Thank you for taking time to provide feedback on my workshop.

Please feel free to be honest in your responses.  Your insight helps me create and offer the most effective programming possible!

Please rate the workshop overall.

On a scale of 1 to 5 (1 being the least satisfied, 5 being the most satisfied)
Please rate the presenter (or coach):

On a scale of 1 to 5 (1 being the least satisfied, 5 being the most satisfied)
Please rate the value of the information/insight.

On a scale of 1 to 5 (1 being the least satisfied, 5 being the most satisfied)
Please rate the value of any handouts, worksheets, practice tasks or homework provided.

On a scale of 1 to 5 (1 being the least satisfied, 5 being the most satisfied)
Please rate the audio/visual components of the presentation, if applicable.

On a scale of 1 to 5 (1 being the least satisfied, 5 being the most satisfied)
Would you recommend this workshop, company or coach to a friend?
Please rate the cost/value of this workshop.

On a scale of 1 to 5 (1 being the least satisfied, 5 being the most satisfied)
What program/workshop did you participate in? (Required)

Thank you for visiting!  I look forward to connecting with you again!


Quick Support:


Referrals are the greatest form of flattery and greatly appreciated at Achieve Life Balance.  As a Thank You, both you and your referral have the opportunity to receive a discount on future services. Visit the referral page for details or fill out this form to get started.   





I’d Love To Hear From You