Tell Me About Yourself

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Thank you reaching out!

Before securing your spot on my calendar, please take a few minutes to fill out the answers to the questions below. Your answers will help me see if we are a good match for each other. I will follow up in a couple days to schedule a consultation or recommend an alternative resource if we are not a good fit.

1) Rate each of the following Attraction/Relationship areas, from 1- 5

(5 being you can't imagine it could possibly be any better). There’s no judgment here, so be honest. Otherwise we can’t get you to where you want to be!

I am attracting the women I really want

I feel great/confident about myself

I know what I want with women

I feel right/good about what I want with women

I feel free to ask women out and ask for what I want/need with women

I appreciate and respect women

I really care about them as human beings

I have access to my emotions and feel "embodied"

I feel centered, clear & on purpose in my life and work

I feel great about my sexual desires and am free to express myself sexually

My relationships with other men are honest and a great support in my life

I am attracting the women I really want

I feel great/confident about myself

I know what I want with women

I feel right/good about what I want with women

I feel free to ask women out and ask for what I want/need with women

I appreciate and respect women

I really care about them as human beings

I have access to my emotions and feel "embodied"

I feel centered, clear & on purpose in my life and work

I feel great about my sexual desires and am free to express myself sexually

My relationships with other men are honest and a great support in my life

Clear selection

2) Which of the areas above do you most want change in over the next 3-6 months?

3) Describe what your connections and relationships with women would be like if there was nothing limiting you or holding your back...

4. What three things are you most tolerating or putting up with in your life?

Which of these are you ready to handle?

5) Assuming all human beings have some way of holding back or sabotaging our lives, which are your favorite methods?

Procrastination

Indecisiveness

Arrogance or being right

Acting as Lone Ranger

Tolerating

Not saying No

Not saying Yes

Controlling life or people

Following secondary goals (i.e. goals that won't ultimately make me happy)

Not telling the absolute truth

Other:

6) What would you get from coaching that would be most valuable to you? (Choose up to 3)

Challenge

Accountability

Focus

Support

Inspiration

Direction

Sounding Board

Ideas/Strategies

Validation

7) How coachable (open to input and feedback; comfortable in partnership; ready to make changes) do you suspect you are?

Highly

Reasonably

I'm trouble

Clear selection

8) Primary Interest:

Ready to dive into coaching

Considering hiring a coach

One-off session simply to see what coaching is about

I'm not looking for a coach right now

Clear selection

Personal Details

Full Name: *

Email (Please check spelling): *

Cell Phone:

Other Phone:

State/Province:

Country:

Comments:

How did you find me? *

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