Time to take your business to the next level. Ready to begin?
Hi there! My name is Robbie Samuels and I'm a business growth strategy coach. I'm looking forward to discussing how I can best support your ability to have greater impact and receive greater income.

You'll see below that there are several ways we might work together (including two new options - a one-day mastermind and twelve-week program that I'm considering piloting but need feedback first). Check all that interest you and we can sort out what makes the most sense for you when we meet.

Before we meet, it would be helpful if you filled out this form so I can better understand what you're hoping to achieve by working with a coach.

Many of my clients have told me they've learned something about themselves just by filling out this intake form so be as thoughtful as you can be with your responses and maybe that will happen for you as well.

My private coaching prices are going up in 2022. If you book before the end of the year you'll receive 2021 prices for the entire package.

Three-hour deep dive is currently $3,000 and will be $3,600. A great way to dig deeper into something you're trying to figure out or to see what it would be like to work together.

​Private coaching is currently $15,000 for six months, including a three-hour deep dive and eleven one-on-one sessions. Next year that package will be $16,500. Twelve months is currently $25,000 and will be $30,000.

Sign in to Google to save your progress. Learn more
Your Name *
Organization
Your Email Address *
Your Phone Number
Where do you want your primary focus to be right now?  What is most important for you to accomplish? Why is that most important to you?  Please be specific and personal. *
What is getting in your way of accomplishing this goal? What changes/actions do you see as being necessary for this to be accomplished? *
If you had a 5-year goal and you had the continuing services of a coach to help you make it happen, and money was not an issue, what would that goal be? What difference would it make for you to work with a coach? *
Imagine it is a year from now.  Write a letter to a trusted individual, describing the past year.  The letter starts with: “This has been a most important time for me . . . “ *
Now that you've gotten a stronger sense of what you want to work on and what's important to you, how would you like to work together? You can select more than one and we can discuss what would be ideal. *
Required
Who referred you? I'd like to thank them.
Anything else you'd like to add?
Next steps...
Robbie Samuels will review your submission and email you to schedule a time to discuss your big dreams and how he can help you achieve them. If you'd like to schedule something more quickly you are welcome to use the booking link on the confirmation page (you'll see this after you hit submit).

Questions? Robbie@RobbieSamuels.com
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy