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About Me
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Coaching
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Work With Me
Please fill out the Questions below
Fill out the form below, and we will be in touch shortly.
What is your name?
What is your best email for staying in touch?
Best Phone Number to reach you
What is your main focus right now?
What is your main focus right now?
Career/Purpose
Physical Health
Peace of Mind
Relationships
Finances
Other
What is one outcome that you would like to achieve in the next 3-6 months that would be life-changing?
What are you uniquely good at?
What is your current yearly income in $USD?
What is your current yearly income in $USD?
$0-50k
$50k-100k
$100k-200k
$200k-500k
$500k+
What would make our coaching relationship a success for you?
What would make our coaching relationship a success for you?
Do you have 1 hr/week to commit to this coaching with me?
Do you have 1 hr/week to commit to this coaching with me?
Yes
No
If you are accepted into this coaching program are you ready to start immediately?
If you are accepted into this coaching program are you ready to start immediately?
Yes
No
Are you on any medication for mental illness? (including anxiety, depression or anything that alters your mental state)
Are you on any medication for mental illness? (including anxiety, depression or anything that alters your mental state)
Yes
No
How did you learn about my coaching?
How did you learn about my coaching?
Anything you want me to consider when reviewing your application?
Anything you want me to consider when reviewing your application?
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