First and last name
What is your age?
Are you currently working with a coach or enrolled in any personal and/or business development programs? Please let me know of any coaching and/or training you have recently completed.
Why are you seeking coaching at this time?
What is your #1 intention in booking a consultation with me?
Which area(s) of your life are you primarily interested in improving? (please select all that apply)
Overall Health & Well-Being
Life in general
What do you want to accomplish as a result of having me coach you? What is your BIG vision?
Do you understand that it is your responsibility to fully commit, do the work required, and that your success essentially relies upon you?
Do you understand that working with me means a significant financial commitment?
Yes, I'm ready to invest in myself!
No, I did not realize this.
Who typically makes the decisions when it comes to investing in your future?
My spouse or life partner does.
A family member makes the decisions.
Are you the type of person who makes excuses, blames others for your misfortunes, or typically doesn't finish what they start?
How did you hear about me?
Thank you! I look forward to talking to you soon. Feel free to add anything else below my signature.
A copy of your responses will be emailed to the address you provided.
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