Private Coaching Application
Hi Gorgeous!

Please fill out this form to the best of your ability. We’ll personally be in touch as soon as possible to let you know whether we can offer you a phone consultation with Jamie.

Email address *
First and Last Name *
Your answer
Phone Number *
Your answer
Birthday *
MM
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DD
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YYYY
Website (if applicable)
Your answer
Time Zone *
Your answer
Why are you interested in working with a coach? *
Your answer
Why are you interested in working with Jamie? *
Your answer
Describe your current love life. *
Your answer
What is your biggest challenge in life (and/or love) right now? *
Your answer
Describe your ideal love life. In a perfect world, how would your love life look one year from today? *
Your answer
What is the biggest obstacle standing in between you and your ideal love life? *
Your answer
On a scale of 1-10, how important is it for you to address this obstacle? *
Not important at all
There's nothing more important to me
How long have you been struggling with this issue? *
Your answer
What steps have you taken to attempt to overcome this issue? *
Your answer
Why is now the time for you to resolve this (one way or another)? *
Your answer
What other personal/professional programs have you taken? *
Your answer
Have you worked one on one with a coach before? If so, what was your experience like? *
Your answer
What would it mean to you to work with Jamie? *
Your answer
How motivated are you to invest your time, energy, and money to reach your goals? *
Not at all motivated
This is the most important thing to me right now
How ready, willing and able are you to shift whatever is keeping your stuck as soon as possible? *
I'm not ready or willing right now
I'm 100% ready to change whatever I need to reach my goals
Do you have or are you willing to find the funds to be a part of this program? (It’s a $5,000 investment if paid in full. Monthly installments include 3 payments of $1,950 or 12 payments of $500.) *
What do you most hope to gain/achieve from working with Jamie? *
Your answer
Any last questions or comments for Jamie as she considers your application?
Your answer
A copy of your responses will be emailed to the address you provided.
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