MLMW Prospective Client Inquiry Form
Welcome to Mindful Life, Mindful Work, Inc. Our clients report greater clarity, confidence, and conviction as they step into the next iteration of their professional and personal life, including companies seeking to mindfully develop their leaders, teams, and organizational culture. Our services are uniquely tailored to each client we serve, whether an individual or an entire organization. Please take as much time as you need to answer the questions below, as this will help us assess if our services are a match for the goals you want to achieve.
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Email *
Full Name: *
Phone Number: *
 How did you come to hear of Mindful Life, Mindful Work, Inc? *
Is there anything specific about our approach or orientation that is particularly appealing to you? *
For whom are you seeking services? (Check all that apply) *
If you marked "Company", please provide the company name below.
If you marked "Other", please explain below.
What general type of support are you seeking? (Check all that apply) *
What is the funding source for this project? *
On what timeline are you seeking services? *
Which broad area of services are you seeking? (Check all that apply) *
Potential Scope of Work? (Check all that apply) *
Please share some specifics about your current situation and the support you think would be helpful; include any relevant personal and/or company history.
If seeking one-on-one coaching, do you have a gender preference for your coach?
If you selected 'other', please list other gender preference.
For individual work, is there a specific Mindful Life, Mindful Work, Inc. coach or coaches that you'd prefer to work with? If so, please list their names here.
Is there any other contextual material that you think would be helpful for us to know in considering if our services are a fit for your situation?
Thank you!
Thank you for taking the time to fill out this form, as this helps us assess if our services are a potential fit for helping you to achieve your goals. You can expect to hear back from us in no more than three working days; if you do not hear from us within this period, feel free to send a follow-up email ( to make sure we received your initial inquiry.
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