Complimentary Consultation Application Form

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By filling out this application, you are finally saying yes to your greatest self and to what is sure to be one of the most fulfilling and empowering journeys you will ever take.

Please fill out the form completely and someone from Kim's team will contact you soon.

Note: Submitting this application does not guarantee your acceptance into any of Kim’s programs nor commit you to a program.
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Full Name* This field is required.
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E-mail Address* This field is required.
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Gender
Please Select
Please Select
Agender
Androgyne
Androgynes
Androgynous
Asexual
Bigender
Cis
Cisgender
Enby
F2M
FTM
Female to Male
Female to male trans man
Female to male transgender man
Female to male transsexual man
Gender Fluid
Gender Nonconforming
Gender Questioning
Gender Variant
Gender neutral
Genderqueer
Intersex
Intersex man
Intersex person
Intersex woman
M2F
MTE
Male to Female
Male to female trans woman
Male to female transgender woman
Male to female transsexual woman
Neutrois
Non-binary
Pangender
Polygender
T* man
T* woman
Trans
Trans Female
Trans Male
Trans Person
Trans man
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Trans*Female
Trans*Male
Trans* Man
Trans*Person
Trans*Woman
Transexual
Transexual Female
Transexual Male
Transexual Man
Transexual Person
Transexual Woman
Transfeminine
Transgender
Transgender Female
Transgender Male
Transgender Man
Transgender Person
Transgender Woman
Transmasculine
Two* person
Two-spirit
Two-spirit person
Cis Female
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Cis Man
Cis Woman
Cisgender Female
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Cisgender Man
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Man
Woman
I use another term
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Phone Number* This field is required.
Area Code
Phone Number
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Date of BirthPlease use the arrows << < > >> to select the correct date
Day
Month
Year
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Please select your preferred time (PST) for your session. If your selected time falls on a holiday the appointment will be rescheduled to Kim’s next availability.
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Address
Street Address
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City
State / Province
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Canada
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Afghanistan
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Other
Country
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If you were to work with a coach like Kim, what are the top three things that you would like to accomplish within the next 6-12 months?
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Which statement(s) most accurately reflect(s) your life today? *Choose as many as you wish.
Things are good, and I want more out of my life
I am ready for change and want more clarity
I have a big vision yet not sure how to get there
I could use support with a major transition
I could use help with issues in my personal life
I am frustrated because I am not living up to my full potential
I feel disconnected from my soul/true self/essence/God
I am bored and living on autopilot
I feel empty inside
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Which areas of your life are you experiencing the greatest struggle at this time? *Choose as many as you wish.
Business/Career
Finances
Sense of Purpose/Meaning in Life
Relationship
Health
Emotional Health
Spirituality
Other
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What do you feel has been keeping you from achieving your full potential?
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How relaxed are you in your daily life?
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Not Relaxed
Extremely Relaxed
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How would you rate your level of health and wellness?
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Very Low
Highest Ever
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What is your occupation?* This field is required.
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What do you like/dislike about it?
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How long have you been doing this?
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Are you open to unconventional methods being used in your coaching sessions?* This field is required.
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No. I like feeling stuck
Absolutely, please work with my subconscious
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Have you ever worked with a high-level coach before?* This field is required.
Yes
No
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If YES, when?
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If YES, what didn't work/worked?
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If NO, Why are you considering a high-level coach now?
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How committed are you to achieving your goals?* This field is required.
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Not at all
Completely
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Please take a clear photo of yourself.
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In the event that your device does not have a camera please upload a recent photo of yourself.
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How did you hear about Kim?
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How do you believe a coach like Kim could help you?
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Feelings of sadness, anxiety, worry, irritability, or sleep problems are common for most people. However, when these feelings get very intense, last for a long period of time, and begin to interfere with school, work, and relationships, it may be a sign of mental illness. Do you feel that you may be experiencing mental illness? (*Kim does not coach individuals experiencing mental illness without permission from a primary health care provider.)* This field is required.
YESNO
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Are you having thoughts of harming yourself or trying to take your own life? (*Kim does not coach individuals who are experiencing suicidal feelings. Please call 'Talk Suicide Canada' 1.833.456.4566, SMS: 45645 )* This field is required.
YESNO
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Policies and Procedures * This field is required.The following policies and procedures apply to all coaching services with Kim M. U-Ming. *Confidentiality: The coach agrees to hold the content of each session confidential. This creates a strong foundation and alliance that supports the client in reaching their goals. *The client understands coaching is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease. *The client understands that coaching is not to be used as a substitute for professional advice by legal, mental, medical or other qualified professionals and will seek independent professional guidance for such matters. If the Client is currently under the care of a mental health professional, the Coach will recommend that the Client inform the mental health care provider. *The client agrees to communicate honestly, be open to feedback assistance, and create the time and energy to participate fully in the program. *Changes: If you need to reschedule a session, please provide a minimum of 48 hours notice. *The client is the sole decision-maker throughout the coaching process. The client is responsible for creating and implementing his/her own physical, mental and emotional well-being, decisions, choices, actions and results. Any and all actions or consequences resulting from the coaching session are the responsibility of the client. As such, the Client agrees that the Coach is not and will not be liable for any actions or inaction, or for any direct or indirect result of any services provided by the Coach.
Clear
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Kim’s most sought-after, short-term coaching programs begin at $6840.00 If you are accepted as a client, are you ready to invest in yourself today?* This field is required.
Yes
No
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