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Email *
First Name *
Last Name *
Email *
Phone Number *
City, State *
Country *
How did you hear about us?
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Have you worked with a 1:1 coach or invested in your personal development before? (If yes, what kind?)
"Measurement is the first step that leads to control and eventually to improvement. If you can't measure something, you can't understand it. If you can't understand it, you can't control it. If you can't control it, you can't improve it."   - H. James Harrington
Please rate yourself in the following areas on a scale of 1 (lowest) to 10 (highest):
Health: I  feel that my overall physical and emotional health (my well-being) is primed and optimized to make me feel energetic and strong each day. I strive to eat well, sleep well, and work out so that I have the physical vibrancy and stamina to enjoy life and deal with its challenges and opportunities. *
Love: I feel a consistently deep, trusting, appreciative, soulful, loving connection with my significant other (or self). I am patient, respectful an attentive to my partner's needs.
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Family and Friends: My immediate social circle of family and friends brings connection, fun and positive energy into my life. I seek out positive people and I do my very best to bring positive energy and real authenticity into all my relationships.
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Mission: I feel clear, energized and fulfilled by my work and contribution to the world. I believe my work or day's efforts adds real value to the world and is a true reflection of my best efforts and contributions. I enjoy the lifestyle my work is helping me experience in life. 
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Finances: I have the level of abundance I need to have a stable income and lifestyle I desire for myself and my family. I earn and invest at the levels I had hoped at this time in my life. I have a clear vision for improving my finances and lifestyle in the next few years. 
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Hobby: I have a passionate past-time that allows me to express, enjoy or develop myself outside of my job/career. I give enough time to the things I love in life.
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Spirit: I feel connected to the present moment and vitally alive in my spirit. I am congruent with my beliefs and behaviors and I keep my faith and values at the forefront of my decisions and daily actions.
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What do you do for a living, and why did you choose that career? *
What are your top 3 goals you are striving to achieve right now? *
What major stressors or challenges are you struggling with right now?
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When you feel like your most successful and happy self, what makes you feel that way? *
What would your dream life look like if you could wave a wand and make it happen?
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What else has prevented you from having that dream life? *
What goal or dream have you ever given up on, failed at, or had to put on hold? *
What 3 big changes would you like to make in your life in the next 12 months?
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What are you most proud of and excited about in your life? *
Why would you like to work with a high performance coach? *
Appreciate you taking the time to fill this all out! Is there anything else you'd like me to know? *
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