Name
Email
How did you hear about me? Website
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Time and Energy Template
Podcast
Personal Connection
Client Referral
Other
What is your profession/industry?
What significant (to you!) life, career, family, or lifestyle change(s) are you considering? Please describe.
What are the biggest barriers to implementing the life change you mentioned above?
What (if anything) have you tried to begin implementing this change? What was the outcome?
What kind of support do you need to successfully implement this change? Please describe all relevant factors.
Why do you want to coach with me right now? (Why me, why now?)
Besides yourself, will anyone else be involved in your decision to invest in coaching? (E.g., spouse, partner)
Describe what isn't working for you in your life right now. What are you struggling with the most? (Ex: I'm feeling unfulfilled at my job and it's affecting all areas of my life.) Please be as descriptive as possible.
What do you want MORE of in your life?
What do you want LESS of in your life?
What do you honestly feel is holding you back from being where you want to be in your life, career, or relationships right now?
What would you like to be different in your life in 6 months? 1 year? 5-10 years?
What results or outcomes would you like to see as a result of our coaching together? Please be as precise, specific, and detailed as possible!
Have you ever worked with a coach before? If yes, describe your experience:
I am ready to make this financial, time, and energy investment in myself and my future.
SUBMIT