Personal Success Coaching Application
My goal is to ensure you are equipped to take action that leads to your dreamiest personal life! Fill this out and we'll explore if this could be a great fit!
What's your name?
Best phone number to reach you at?
Preferred method of contact
Phone - texting
Phone - call
How many years have you had your business?
If you have more than one business, please answer this regarding the one you plan to talk about the most with me.
I do not have a business
How much gross revenue are you bringing in annually in your business?
If you have more than one business, please answer this regarding the one you plan to talk about the most with me
I do not have a business
What feels like your biggest pain point right now?
My health (energy level, fitness level, nutrition)
Communication (feeling misunderstood, or unsure what to say)
My home (organization, wanting to host more, look + feel)
Relationships (feeling lack luster, or like they're not thriving like they could be)
My romantic relationship status is...
I am single (and I'm making the most of this season)
I am single (and I'm sick of it)
I am in a dating relationship (casual)
I am in a dating relationship (I like him a lot)
I am in a serious, committed relationship (not yet married)
I am engaged
I am married
It's complicated and I don't really know how I feel about it
It's complicated and I'm good with how things are
How many kids do you have?
How would you rate your physical health habits (nutrition and fitness-wise)?
It's definitely a priority in my life
I'm pretty good - some room for improvement
Hit or miss - I tend to go in waves with it
It's not a priority for me - too many other things to focus on
Please pick the top 4 areas you would love to get support in
It's okay if you want support in ALL of these. Just pick the 4 that are the deepest desire on your heart right now!
Philanthropic / Legacy / Giving Back / Community Service / Volunteer / Purpose
Personal Development / Education / Intellectual
Self care / Self love
Health / Physical
Entertainment / Adventure / Recreation / Activities / Travel
Relationships (business / colleagues / employees / employers)
How well do you receive direct feedback?
I welcome and encourage it - help me grow!
Pretty well - as long as it's delivered on the gentler side
I only want feedback that's positive
Keep it to yourself
Have you ever worked with a coach before?
No, this will be my first time
If you answered "Yes" above, please share with me what had you step away from working with them further?
There's no judgement here - the more transparent you can be, the better I can support! What worked? What didn't work? What did you like/not like? etc...
What is the #1 thing you would like to accomplish over the course of our time working together?
I am inviting you to BE with this question, and respond with something more than "I'm not sure." You are filling out this application for a reason - what's that reason? ;)
Are you ready to invest in your success?
Yes, absolutely - Let's do this!
I'm not sure if this is the route I want to take or not - curious to find out
Not at this time, but it was helpful to go through these questions! I already have more clarity than when I started!
How did you hear about me?
A copy of your responses will be emailed to the address you provided.
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