Coaching Questionnaire - Addiction-Free Pain Management®

Coaching Questionnaire

Please complete the following information. Please note, * fields are REQUIRED.

1 - I am open to recommendations from health care providers, family and friends who want to support me in becoming physically and emotionally healthy.	Yes No
2 - I am willing to believe there is hope for me and that I can have an addiction-free life.	Yes No
3 - I am willing to take charge of my pain management health and work toward improving the quality of my life.	Yes No
4 - I have the necessary support of health care professionals in order to participate in pain management coaching.	Yes No
5 - I am willing to adopt new patterns of thinking, feeling and action to support my success.	Yes No
6 - I am willing to learn new skills and be open to suggestions from my pain management team.	Yes No
7 - I am willing to go beyond where I've stopped myself in the past when I attempted to improve my health.	Yes No
8 - I am willing to be supported in achieving my pain management goals.	Yes No
9 - Coaching is the right path for the changes I want to make. I understand it is not therapy, counseling or 12 Step work.	Yes No
10 - I can be relied upon to be on time for calls and appointments.	Yes No
11 - I am willing to invest time, effort and money towards my health and healing.	Yes No
12 - I am willing to use pain management coaching as a way to invest in my life.	Yes No
Find Out What Your Answers Mean.
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