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VIP Call with Shira
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Email
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Your email
Name (first and last)
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Date of Birth
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Address (Street, City, State, Country)
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Phone number
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Health Status (physical and mental)
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Do you work? If so, how long have you been at your current employment? Are you happy at your current employment? If no, please tell me briefly how you spend your time and if you are satisfied with that.
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Please share a bit about some of the important people in your life: (spouse/partner, children, friends)
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Are you seeing a therapist at this time? If yes, briefly describe reason for seeing a therapist.
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Have you experienced any trauma or abuse in your life?
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Do you take any medications? If yes, please name what you are taking medications for.
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Where would you like to get unstuck in your life and have you ever been coached before? If yes, please describe the experience:
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How did you hear about me?
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What influenced your decision to work with me?
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The cost of this 1st time clarity session with me is $157. Do you recognize the value of this coaching session and are you ready to invest in it?
Yes! I realize the value of this investment. I am ready now! Please contact me asap.
Maybe. I know I would benefit from it, but I’m not sure now is the right time.
No. I’m not ready to invest in myself right now.
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Is there anything else you would like me to know about you or your circumstances before we meet?
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