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Advice Actually Intake Form
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Email
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Your email
First name
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Your answer
Last name
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Your answer
Address
Your answer
What are you wanting help with? (Please be specific and detailed.)
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Your answer
What have you already tried?
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Your answer
What do you think is keeping you from achieving your goal?
Your answer
If we worked together, what would you like to see happen over the next 3 to 6 months in order to make this a successful experience for you?
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Your answer
What is your personality like? What kind of coaching style do you prefer: direct / gentle / challenging / etc. ?
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Your answer
What major changes have you experienced in the last 2 years?
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Your answer
What 5 adjectives would someone use to describe you at your best?
Your answer
How would they describe you at your worst?
Your answer
What causes you to feel motivated?
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Your answer
What is your personal and/or professional vision of where you want to see yourself a year from now? Be as specific as possible and as descriptive as you would like.
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Your answer
What intentions do you have for your life presently?
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Your answer
On average, clients invest $5,500 - $15,000 with me. Are you ready to invest in yourself?
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Yes
No
On a scale of 1-10 (10 high), what is the quality of your life today?
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10
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