1:1 Application Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Which Package are you enquiring about* This field is required.
Group coaching
The Quantum Switch 6 months 1:1
The Cognitive Switch 16 week 1:1
Anything else
4
What is the main reason for you applying to work with me?* This field is required.
5
Based on your choice, what would you specifically like to achieve from this coaching package?* This field is required.
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Ok
6
What do you feel has kept you from achieving this?* This field is required.
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7
Have you worked with anyone else, regarding this? If so, explain below.* This field is required.
8
Are you currently working with anyone to support you 1:1. If so, detail below.* This field is required.
9
Tell me more about your business. What do you do, how much are you making, and any problems you feel you are facing that you would like to work on?* This field is required.
10
If there were three things you could change in your life, business, and personally right now, what would it be?* This field is required.
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11
How would you describe your current mindset, energy state, and emotional intelligence? Please go into detail.* This field is required.Please mention any emotions, behaviours or states and limiting beliefs that you feel require support and why you feel it exists.
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12
Pending on your coaching package choice, are you in a place to invest.* This field is required.Investment will be between £8000-£25,000. Payment plans are available.
Not right now
I am ready to invest
I can obtain the investment
I would like to discuss other options
13
Once approved, when would you be available to begin your transformation?* This field is required.Please note that there will be no gaps between any sessions, unless dire emergency occurs.
Date
Year
Month
Day
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