Lifestyle Strategy Session Intake Form
Thank your for your interest in my Lifestyle Mastery Coaching Program. Space is limited! In order to determine if the program is a good fit for you, please complete this brief application to attend a complimentary Lifestyle Strategy Session with me, your lifestyle coach.

This powerful strategy session includes:
- A comprehensive lifestyle inventory to determine your unique needs and values.
- An in-depth analysis of your personal and professional goals and motivation.
- Lifestyle recommendations to get you started on your path to achieving your goals and making your impact.
- If we both feel you are a good fit for the program, you'll be invited to sign up for the Lifestyle Mastery Coaching Program and we'll choose your start date!

Do I need to live near Portland, ME to participate in this session?
No, remote coaching is available for those in other towns/states.

How much does this session cost?
Nothing, complimentary and risk free!

Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
Please rate your level of motivation to create lasting lifestyle change in favor of your goals. *
Very un-motivated
Very motivated
How you been successful in changing lifestyle habits before? If so, please provide an example. *
Your answer
What is one thing you are motivated to change within your current lifestyle and why? *
Your answer
Are you committed to prioritizing your health and happiness and willing to invest time and money in yourself to gain the support you need? *
Do your partner, spouse and/or dependents support you in spending time and money to elevate your health, happiness and potential at this time? *
Why do you want to participate in my Lifestyle Mastery Coaching Program? *
Your answer
Thank you for your interest in becoming a healthier, happier, more effective person. The world needs more people like you!
I will be in touch within 3 business days to let you know if you qualify.

Be well,

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