Mindset Coaching Application
Thank you for your interest in working with me! Fill out this form and I'll get back in touch if we seem like the right fit. Every question is required. Should you need any assistance, email contact@rebeccaksampson.com.

* Mindset Coaching Goals *

As we work together, you will gain the following...

- A clearer idea of what your ideal life would be
- Get closer to the feelings identified in Q5
- Provide support in day to day life and personal goals
- An ear to listen

View more information on rebeccaksampson.com/coaching

If this sounds like a coaching relationship you'd like to enter, apply below and I will be in touch.

NOTE: There are no wrong answers. The purpose of this application is so I can see if my skill set would be helpful for your needs, as well as help me get to know you.
Email address *
Full Name: *
Instagram handle: *
If you could be, do, and have everything you wanted - what would your life look like? *
What are your primary feelings in this ideal life? *
How does this dream differ from your current life? What do you want more of in your life and less of? *
What do you see as challenges from getting closer to your dreams? *
What changes do you want to have in your life in 12 months? *
If you could describe how you want to feel in one word, what would it be? *
This coaching relationship includes two calls a month. Are you available to talk two times a month for one hour each session? *
Of the four coaching options on rebeccaksampson.com/coaching, which coaching package do you want to book. wth me? *
A copy of your responses will be emailed to the address you provided.
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