Coaching Application 
Please answer all questions. After submitting your answers, I will review the info provided and determine if you we are a good match for coaching. Thank you.
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Email *
First/Last Name *
Phone number (please include area code) *
How did you hear about Max? *
How old are you? *
What challenges are you currently experiencing ? *
How have you approached dealing with these challenges? (Prior meetings with Therapist, Coach, self-help etc…?) *
On a scale of 1-5, how motivated are you to put in the required work necessary to see real change and growth in your life and outlook? *
On a scale of 1-5, how secure do you feel financially?  (Coaching is an investment in yourself and your life) *
Are there any obstacles getting in the way of you moving forward with coaching at this time? *
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