High Performance Coaching Session

Name *

First

Last *

Last

Email *

Phone *

Address *

Address

City

State/Province

Zip/Postal

Best Time to Contact You *

Birth Date *

Gender *

Marital Status *

Please briefly describe how you heard about me and why you would like a Discovery Session: *

Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest)

Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? *

Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? *

Courage: Do you take action and consistently express who you truly are and what you think, need, and desire with this world? *

Productivity: Are you consistently focused and effective, are you good at minimizing distractions and maintaining priorities? *

Influence: Do you feel you have the social influence with your family, friends and team needed to accomplish your goals? *

What do you do for a living? Explain why you chose that career. *

What are the top three goals you are striving to achieve? *

What major stressors and challenges are you struggling with? *

When you feel like your most successful and happy self, what makes you feel that way? *

What would your dream life look like if you could wave a wand and make it happen? *

What has prevented you from having that dream? *

What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail? *

What three big changes would you like to make in your life in the next twelve months? *

What are you most proud of and excited about in your life? *

Why would you like to work with a High Performance Coach? *