First Impression Activation Consultation Application
Congratulations for saying yes to this FIRST IMPRESSION CONSULTATION!

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 I’m the best match for you.

I will follow up in a couple days to schedule a consultation or recommend an alternative resource.

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!
1
2
3
4
5
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
2) Which of the areas above do you most want change in over the next 3-6 months?
Your answer
3) Describe what your connections and relationships with women would be like if there was nothing limiting you or holding your back...
Your answer
4. What three things are you most tolerating or putting up with in your life?
Your answer
Which of these are you ready to handle?
Your answer
5) Assuming all human beings have some way of holding back or sabotaging our lives, which are your favorite methods?
6) What would you get from coaching that would be most valuable to you? (Choose up to 3)
7) How coachable (open to input and feedback; comfortable in partnership; ready to make changes) do you suspect you are?
8) Primary Interest:
Personal Details
Full Name:
Your answer
Email (Please check spelling):
Your answer
Cell Phone:
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Other Phone:
Your answer
State/Province:
Your answer
State/Province:
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Country:
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Comments:
Your answer
How did you find me?
Your answer
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