Email address *

Tell me your name *

Why are you interested in coaching? *

What do you hope to accomplish with coaching? *

Do you believe you will achieve your desired result? *
YesNo

Are you willing to try all the exercises and homework? (Especially the ones you have resistance to?) *
YesNo

What is your biggest fear in life? *

Write down five major positive events in your life. *

Write down five major negative events in your life. *

What is the thing you most want to change in you life? *

What ARE you willing to sacrifice to change your life? *

What AREN'T you willing to sacrifice to change your life? *

Would anyone in your life be upset if you changed? *

On a scale from 1-10 (10 being the most important), how important is it for you to make changes in your life? *
12345678910

Are you willing to spend between $5,000 and $10,000 on coaching to make these changes in your life? *
YesNo

What will happen if you don't change? What will it cost you? *

What is the most upsetting issue pressing on you now? *

What do you fear about this situation? *

How do you currently manage stress? *

How much joy do you currently create in your life? *

What gives your life meaning? *

Do you believe you are living the life you were meant to live? *
YesNo

What do you want other people to know about you? *

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