Pre-qualification Assessment Form

Instructions: Answer these questions honestly to assess your readiness for one-on-one mindset coaching. If you prequalify, someone from DG Mindset will contact you within the next 48 hours to set up a free consultation call. 

Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
Email *
Date of Birth *
MM
/
DD
/
YYYY
What are the top three challenges you want to work on with a coach?
 *
On a scale of 1-10, how committed are you to making meaningful changes in your life? (1 = Not committed, 10 = Fully committed)
 *
What do you believe is holding you back from achieving your goals?
 *
How do you typically handle challenges or setbacks?
 *
Are you open to receiving direct feedback and implementing new strategies for personal growth? Why or why not?
 *
What fears or limiting beliefs do you struggle with the most?
 *
On a scale of 1-10, how financially prepared are you to invest in high-level coaching? (1 = Not prepared, 10 = Fully prepared)
 *
If you knew that coaching could significantly transform your mindset and life, would you be willing to make financial adjustments to prioritize it? Why or why not?
 *
What would need to happen for you to feel that your coaching investment was worthwhile?
 *
If we were to create a payment plan that fits your needs, would that make coaching more accessible for you?
 *
If coaching helps you achieve the breakthroughs you desire, how do you think that would impact your life financially and emotionally?
 *
Have you ever regretted investing in yourself? If not, what has been the most valuable investment you’ve made in your personal growth?
 *
Do you see this investment as an expense, or do you view it as a long-term investment in your transformation?
 *
One-on-one coaching packages range from $2,500 to $10,000, with a 3-6 month commitment depending on the level of support and transformation you seek. Are you ready and willing to invest in yourself at this level?
 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms