POWERHOUSE 1:1 Coaching Application
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
What are you doing for work?
Level of satisfaction in your work?
Sucks
1
2
3
4
Epic
5
1 is Sucks, 5 is Epic
Which of these best describes how you feel? (select as many as you'd like)
At a plateau personally & professionally
Stuck in my life & career
Need more tools to communicate & process emotion
Afraid of not reaching my potential
Having an identity crisis
Things are good on paper, but I'm not fulfilled
Lacking confidence
Which of these best describes you?
*
Retired or Competing Athlete 🏆
High Performer or Executive 👨💼
Entrepreneur or Want-repreneur ⚡️
Other
Have you done therapy or coaching before?
*
Coaching
Therapy
Group Coaching / Mastermind
Other
Have you done therapy or coaching before?
Therapy
Coaching
Other
How did that ^ work for you? Why did it or didn't it work? (be specific & 100% honest with yourself)
*
What are you hoping to GAIN from being coached? *
*
What has been your BIGGEST OBSTACLE lately? (be as exhaustive as possible)*
*
Why should we take you on as a client?
*
Are you ready to invest time, energy, and resources into your next evolution of growth?
*
Yes
No
Are you ready to get uncomfortable & be challenged?
*
Yes
No
What's your money situation? How much are you ready to invest today, if this is a fit?
*
Less than $1,000
$1,000-3,000
$3,000-$7,000
$7,000-$14,000
$14,000+
Anything you feel is important that you'd like us to know?
Submit
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