Confidence Journey

Confidence Journey

Intake Form
Name

First NameLast Name
Age
MaleFemale
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SingleMarriedDivorcedWidowed
Occupation
What are your personal goals?
What are your professional goals?
What changes would you like to make in your life right now?
What are you willing to do to achieve your goals?
What is your motivation in life?
What are your expectations from this coaching relationship?
AGREEMENT/REMINDERS:

I understand that all information I entered in this form will be considered strictly confidential.

The data gathered from this form will only be used as a basis for the type of coaching the client will need.

I understand that in order to be successful, it is vital to follow the plan agreed by both the life coach and the client.
Life Coach Subscription
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Two Sessions$300.00
You will be coached for two- 1 hour sessions. Once at the beginning and once at the closing of your 10 step confidence journey".

Five Sessions$750.00
You will be coached for five- 1 hour sessions. One session for 5 weeks of your 10 step confidence journey.

10 Sessions$1,500.00
You will be coached for ten- 1 hour sessions. One session for 10 weeks of your 10 step confidence journey.

Total $0.00
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