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1) Name *

2) Mobile Phone *

3) Email *

4) What are you seeking a coach for? What isn't working as well as you want in your life and/or business/career? *

5) What is your position (CEO, etc) and business? *

6) Do you take responsibility for your results, are you coachable, and willing to take bold action on what is revealed in our sessions? *

YesNo

7) How urgently do you want these changes? (Scale 1-10 with 10 = I want change now) *

8) What's the toll of not solving these challenges (in dollar terms per year, in health, in relationship)? *

9) Are you able to make this decision to work with me on your own or do you have to ask a spouse for permission? *

I can decide on my ownI need to discuss with spouse/partner

10) Are you able to be resourceful? All investments are 4-figures+. (Yes I am resourceful / No) *

Yes, I am resourcefulNo

You aren’t paying for my time. You’re investing into future outcomes that result from our time together if you put in the work. Let’s not waste either of our time if that isn’t aligned.

11) Which offers are you wanting to explore? *

GrowthShift™ SessionsDay3–12 Month AgreementRetreat

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