Prospective Client Inquiry Form
Welcome to Mindful Life, Mindful Work. Our clients report greater clarity, confidence, and conviction as they step into the next iteration of their personal life, their professional life, or both. Our services are individually designed for 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.
Email address *
Full Name: *
Your answer
Phone Number: *
Your answer
How did you come to hear of Mindful Life, Mindful Work? *
Your answer
Is there anything specific about our approach or orientation that is particularly appealing to you?
Your answer
For whom are you seeking services? (Check all that apply) *
Required
If you marked "Company", please provide the name below.
Your answer
If you marked "Other", please explain below.
Your answer
Please tell us a bit about your personal background, your company's history, or both.
Your answer
What type of support are you seeking? (Check all that apply) *
Required
Describe your current situation and goals in some detail.
Your answer
Which broad area of services are you seeking? (Check all that apply) *
Required
Please share as much detail as possible about the services you are seeking.
Your answer
Potential Scope of Work? (Check all that apply) *
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Please add more detail for the potential scope of work.
Your answer
What is the funding source for this project? *
Required
If seeking one-on-one coaching, do you have a gender preference for your coach?
Please list other gender preference.
Your answer
Is there a specific Mindful Life, Mindful Work coach that you'd like to work with? If so, please list them here.
Your answer
On what timeline are you seeking services? *
Required
Please elaborate on your timeline answer above.
Your answer
Is there any other contextual material that you think would be helpful for us in considering if our services are a fit for your situation?
Your answer
Please list a few general times (specify time zone) each week that you may be available for a free introductory call... hearing more about your goals will help us better assess if our services are a good fit. We’ll email you to set up a time for our call. *
Your answer
Thank you!
Thank you for taking the time to fill out this form... you can expect to hear back from us in no more than three working days; if you do not hear back from us within this time period, feel free to send a follow-up email (info@mindfullifemindfulwork.com) to make sure we received your initial inquiry.

Thank you for contacting Mindful Life, Mindful Work... we look forward to hearing more about the vision you have for your life and work.

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