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Oh yess!!! Let's do this! Complete the following intake form and then book a time to schedule your 90-minute kickoff call. The cost of the call is deducted from the coaching package.
First Name
E-mail
Have you ever worked with a life/mindset coach before?
Yes
No
Preferred coaching/learning style:
1:1 Private Coaching (phone calls included)
Self-paced (group coaching call included)
Length of coaching:
I really just need help with overcoming one obstacle and need guidance but I can apply it on my own
I'm interested in doing inner work, applying what I've learned, and working on a long-term basis for continued support and accountability
Timeframe to hire someone to help you break free and start working towards your goal:
Just looking with no definite date
Now
1-3 months
4-6 months
What are you currently struggling with? (select all that apply)
Confidence
Being happy
Showing up in business
Self-limiting beliefs or negative self-talk
Constant approval seeking
Accountability and support
Self-sabotage
Fear
Procrastination
Meeting or accomplishing specific goal
What are some habits you normally have? (select all that apply)
Waiting
Overthinking
Perfectionism
Avoiding
Staying behind the scenes (hiding)
Complaining
Arguing with yourself
Being super critical of self
Playing the victim
Lack of self-trust
Stress Eating or Emotional Eating
When something goes wrong, who do you naturally blame?
Self
Other person
God/Universe
Nobody
When something is hard, I:
Give up
Ask for help
Look for solutions
Take a break and try again later
Burn myself out until I figure it out
What is usually the reason you do not accomplish your goal?
Lack the skills
Not consistent
Talk self out of it
Do not have a clear plan to accomplish it (I know what I want but not how to get it)
Easily discouraged by comparing self to others
Easily discouraged by the negative things other people say
Can't work out
Don't know types of food to eat
How much weight would you like to lose?
0-25lbs
26-50lbs
51-75lbs
76-100lbs
100+lbs
How would you feel if you didn’t meet goal? (Refer to last question about something you want to accomplish in 30 days).
It wasn't meant to be
Better luck next time
Will find a way
Devastated
Have you been diagnosed with anxiety, clinical depression, ADHD or any other condition?
Yes
No
If you responded “yes” to the previous question, how are you managing? If you answered “no”, please skip this question.
No longer struggle with it
Holistic health
Medication
Trying to manage the best way I can but it's a struggle
Are you currently seeing a counselor, therapist, psychologist or other mental health professional?
Yes
No
As a coach, do you understand that I cannot diagnose, treat or provide medical advice?
Yes
No
Submit application now >>>
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