Please complete the following questions. Before we have our Breakthrough Call, I would like to learn more about your background, your aspirations and your expectations.
Question 1 of 12
Name
Question 2 of 12
Email Address
Question 3 of 12
Phone Number
Question 4 of 12
What service are you interested in?
Private Practice Coaching & Consulting
Enneagram Coaching
Personal Development Coaching
Parent Coaching
Relationship Coaching
Dialectical Behavior Therapy family & Individual Coaching
Dialectical Behavior Therapy Case Consultation (For Clinicians Only)
Question 5 of 12
On a scale of 1-10 how happy are you with your life right now? 0= Not happy at all; 10- Very Happy
Question 6 of 12
What is most important to you in your life and why?
Question 7 of 12
What are your major objectives or gains that you wish to achieve from coaching/consulting?
Question 8 of 12
How do you want to feel at the end of your coaching/consulting series? (Dig in deep; feel)
Question 9 of 12
What would you like from your coach during your sessions? Please select one or more goals from the list below.
Glain clarity of issues
Gain an insight into who I am
Improve my communication
Gain more confidence
Increase my motivation
Manage stress, work/life balance
Learn to deal with my feelings better
Learn to deal with other peoples' feelings better
Understand what is important /what motivates me
Explore and understand what is holding me back
Help define goals
Help to identify action and next steps
Make me accountable for my goals
Gain an insight into who I am, my strengths, capabilities and potential
Receive encouragement and support
Question 10 of 12
What do you expect to achieve in life as a result of hiring me as your coach/consultant?
Question 11 of 12
What else should I know before we speak?
Question 12 of 12
What else would you like to say?