New Client Registration
Please fill out this form so that we can better understand your needs
Name( First and Last) *
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Address *
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Phone *
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Email *
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Skype Name
If you would like to do your sessions via Skype, please list your username
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Age *
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Gender
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Have you experienced coaching, counseling or career counseling before? *
If so, please describe your experience:
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What topic/issue would you like to be coached on? *
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How would you describe yourself? *
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What are some of your accomplishments? *
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What challenges are you currently facing? *
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What are some of your goals? *
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What has kept you from already making these changes? *
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What are you hoping to get out of these sessions? *
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How will your life be impacted when you have these wants and desires fulfilled? How will you feel when you have manifested your desires? *
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What will you miss out on if, in a year from now, nothing has changed? How will you feel if nothing has changed in a year from now? *
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Are there any medical conditions or life circumstances that will impact the work we’re doing in coaching? If yes, please describe: *
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