Imperfectly Perfect Coaching LLC.
Intake Form
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Survive, Thrive, Arrive through Mindset Shifts and Mindfulness
Name *
Email *
Phone Number *
Tell me a brief synopsis of yourself and why you are interested in coaching.
What do you do for work?
Most of the people I work with have been struggling, feeing unsure, or unhappy for a long, long time.  Tell me, are you ready to commit to changing your life?  On a scale of 1 to 10 where would you rate your readiness for change? *
Enrolling into a coaching program is an investment.  Its an investment into yourself, your mindset, and your life.  With that comes an investment into yourself financially as well.  This can be hard for some people to accept buts it the best investment you could ever make.  Tell me, are you willing to invest in yourself financially? *
Commit to YOU
Instead of saying, "That's too expensive or that might be too expensive" try saying "My Health isn't worth this investment" and see how that sounds and feels.
On a scale of 1 to 10 NOW how ready are you to make a commitment to YOURSELF and CHANGE your life??? *
Are you currently working with another coach, therapist, or other healthcare professional?
What brings you to this program and makes you want to choose this tribe to help you through your journey?
How soon are you ready to start changing your life? *
Is there anything pertinent you wish to share with me now (this form is private and only I access this information). Feel free to leave blank if you do not wish to share at this time. (Write N/A to move to next question). *
What is the best way to contact you? *
Once you submit your application, you will be given a short assignment to complete before your strategy session. Assuming time permits, will you complete the assignment? *
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