Please answer each question below and click submit once. You will be contacted within 48 hours to set up your appointment.
| Please rate your life in the following areas: (1=worst, 5= best) Spiritual Life, Relationships, Finances, Family, Business/Career, Personal Growth |
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| Please select two of the areas above that you would like to work on, that would make the greatest difference in your life. |
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| Please indicate one goal you want to attain in the next 6 months that would make a HUGE difference in your life |
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| What one thing do you want more of in your life right now? |
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| List 3 things you are tolerating now in your personal life or business |
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| What one thing would you like to achieve, but aren't sure how to do it? |
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| Below are some typical results experienced by my coaching clients. Which 3 are most important to you? (direction, focus, accountability, a new perspective, relationship success, strategies, better finances, motivation, new challenges, closer walk with God, other - please list) |
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| How well do you keep your commitments when taking advice or working with someone towards your goals? (very, moderately, not too much) |
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| If we decide to work together, how affordable is the coaching investment? (very, moderately, not affordable) |
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| Considering the goals you have, how long do you think it makes sense to work together to achieve them? ( 3 months, 6 months, 1 year, longer than 1 year) |
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| I understand that if I am not satisfied within the first month, I may cancel my future session(s) within the first month |
| YesNo |
| If after our initial complimentary session we decide to work together, how soon would you like to begin? (within a week, within a month, within the next 90 days) |
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| Is anyone else's agreement required prior to beginning your coaching sessions? (example: company, business partner, spouse) |
| YesNo |
| Your name: |
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| Business name and your title (if applicable): |
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| Email address: |
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| Residential phone: |
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| Cell/mobile phone: |
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| Work phone: |
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| City and State |
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| Country |
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| Your time zone and 2 preferable times for our session |
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| Additional Comments: |
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Your Name:
Your Email: |
