Liberty Savard Life Coaching - Personal Questionnaire

Use the form below to tell me something about yourself and what you expect.

* Required

* I am aware that Rev. Liberty Savard will be coaching me from her experience as an Ordained Minister; her experience as a Christian since 1971; and her background of Bible teaching, preaching, and personal ministry since 1984. I am fully aware that our Life Coaching relationship is not to be considered as psychological counseling or therapy of any kind. By returning this form, I am stating that after considering the above information, I wish to begin our Life Coaching relationship.



*Telephone (Home)

Telephone (Cell)

*E-Mail Address (please type twice)

*Date of Birth

* Male  Female


*Marital Status

*How many marriages

*Years of each

Names/Ages of Children

Please TYPE answers to the following questions as truthfully as you can.
Please do not tell me what you think I want to hear and please do not say what you think you should say.

1. Why do you think you want a life coach and what are you hoping will happen?

2. What makes you genuinely excited or joyful?

3. What do you think are your strengths and your weaknesses?

4. If you could change your life right now to anything you wanted,
where would you be tomorrow and what would you be doing?

5. Do you think you have some hidden talents that no one else has recognized?
What are they?

6. Use five words to describe who you see yourself as right now.

7. Use five words to describe who you would like to be.

8. What five things do you think you are tolerating in your life today that might
be draining your energy?

9. What three things do you think you are procrastinating about in your life today?

*10. How long have you been a Christian?

*11. What books of Liberty's have you read?

*12. Are you praying with the Keys of the Kingdom principles yet?

10. Appointment choices (choose day, time, length as seen below):

Please note that times are in Pacific Standard Time

Choice 1

Choice 2

Choice 3

Fee Schedule

  • $20 for 15 minute appointment
  • $30 for 30 minute appointment
  • $40 for 45 minute appointment
  • $50 for 60 minute appointment

Upon receipt of your questionnaire form including three possible appointment times and payment confirmation from PayPal, I will send you our appointment time. I look forward to speaking with you very much.


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