Coaching Client Interest Form
Thank you for your interest in my coaching program. This application is to make sure we're a good fit for one another before an investment is made, either in time or money. Your success is my priority. In addition to that, I only accept a certain number of clients at a given time. This is both to maintain the level of value I am committed to providing, as well as staying true to my highest priority- my family.

Please complete this form as honestly and vulnerably as you can. The more I can understand your needs, the better I can assess the coaching that will bring you the greatest success.

Disclaimer: All information shared is strictly confidential. 
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Full Name *
Phone Number *
Email Address *
Is there a specific struggle or challenge you're facing, or a particular goal you have in mind? *
Have you ever had coaching or counseling? If so, tell me about your experience.  *
Do you have any hesitations about coaching? *
What are the 3 emotions you experience most often? *
Fill in the blank: I'm ready to feel ___________________. *
What would it mean to you, to feel that way? *
What would keep you from that success? *
Coaching sessions are available during the week, between the hours of 9am-3pm, on a first come first serve basis. Is there a day of the week that works best for you?
Occasional exceptions may be made when possible. Please note as needed at the end of the form.
 *
My 1:1 program typically ranges from 6-12 weeks, with 1 weekly appointment. Are you able to commit to this timeframe? *
On a scale of 1 to 10: If we determine we're a good fit for one another, how prepared are you to financially invest in yourself? *
Unprepared
Let's Go!
Please share any other details you believe would be important for me to know. 
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