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Life Evaluation Questionnaire

Jeff Miller Coaching is focused on your success!

To help you reach your personal goals and strive to be your very best, I have designed a coaching service that provides pertinent tools and guidance to help you examine your endless potential and consider what is possible in your life.

To design a coaching plan that is personally created for you and addresses your particular needs, it is important that I first learn how I can assist you. Below you will find a short series of questions that were developed to uncover areas that could be effecting your relationships, business, personal dreams, career, or your life overall.

Your responses to the questions below, as well as any information shared in a coaching session is always private and confidential. Feel free to answer all of the questions honestly and to the best of your ability.

    Please rate your enjoyment in the following areas, where 0 is low and 10 is high
    • Career:
    • Friendships:
    • Relationships:
    • Achievements:
    • Joy:
    • Success:
    • Serving Others:
    • Financial Security:
    • Well-Being:
    Please answer to the best of your ability.
    • If you were to create your dream life, what would it look like?
    • What is working well for you in your life?
    • What is in the way of you creating your ideal life?
    Please complete the fields below:
    • Name:
    • Email:
    • Telephone:
    • What are you willing to pay for coaching?
    • How did you hear about us?


    If you have any questions, thoughts, or concerns about the form above, please feel free to reach out to me immediately! Thank you!