Life Check Up Form

In order to better prepare for our 20-minute consultation, please fill out the following questionnaire. The questions below will give you an idea of where my clients can benefit from my services. The way you answer will give me direction in how to make our 20 minutes together the most impactful for you in your life.

E-mail

Name

Phone

I am clear on what I really want for myself

I stay focused on what is important to me

I consistently take action toward accomplishing what's important to me

I push through my fears to achieve what I want

I have established the desired environment that gets results

I set goals in a way that I can easily achieve them

I am effective at problem solving and meeting challenges

I know how to recognize the limiting beliefs that hold me back from what I want

I know how to rewrite my rules so I can win the game

I experience balance in my work and personal life

I have plenty of prospects for my business

I know who my perfect customer is

I have a marketing action plan

I am implementing my plan effectively

I would like to explore coaching to help me gain momentum in particular areas of my life

I would like to explore coaching to help me get balance back in my life

Security Question: Create a GREAT 2008 - What should we make 2008?

Other/Comments:

Thank You ~ once submitted, you will hear from us within 24 hours to schedule your complimentary appointment.

PS: Please note your coaching investment may be tax deductible. Expenses of continuing education undertaken to maintain and improve business and professional skills may be tax-deductible (Treas. Reg. 1-162-5. Coughlin VS Commissioner, 203F 2d 307). Please consult your tax advisor.

Life Check Up Form

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