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Use this Page As You See Fit.  Take Notes, Set Your Next Appointment, Contact Susan.

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

Name Email
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)

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 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!


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Or view Terms & Conditions Agreements here: Coaching Client Contract, Court-Ordered Client Contract, Course & Coaching Contract