Private Coaching Application

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Hi!

I'm so glad you're here!

Take a few minutes to fill this out so I can really understand where you are right now and the kind of support you're looking for.

Once you submit your form you will get a text from me to schedule a call. On that call we'll get honest about what's actually standing between you and the business God put on your heart. The more detail you give me here, the better I can serve you when we talk.

If by the end of the call I believe I can help you, I'll walk you through the details of what working together looks like, and you can decide if it's a good fit for you. If I can't help you, I'll tell you that honestly and point you toward someone who can. Either way, you'll leave our call knowing your next step.

Okay, let's get started!

Mia
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What's your full name?* This field is required.
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What's the best email to reach you?* This field is required.
example@example.com
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What's your phone number?* This field is required.
Please enter a valid phone number.
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What's your Instagram handle?
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How did you find me?* This field is required.
Please Select
Please Select
The God-Centered Success podcast
Mia's email list
Instagram
Facebook
Someone referred me
Other
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If you've listened to the podcast, is there an episode or a moment that has stayed with you? Tell me about it.
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Tell me about your business. Who do you help, and what do you offer right now?* This field is required.
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Do you have a podcast?* This field is required.
Please Select
Please Select
Yes, and I publish consistently
Yes, but it's inconsistent or on pause
No, but I've been thinking about it
No, and I'm not sure it's for me
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What are the one to three biggest obstacles standing in your way right now?* This field is required.
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What have you already tried to move past these obstacles? Why do you think it didn't work?* This field is required.
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What is your current monthly revenue?* This field is required.
Please Select
Please Select
$0 to $1,000 per month
$1,000 to $3,000 per month
$3,000 to $5,000 per month
$5,000 to $10,000 per month
$10,000 to $20,000 per month
$20,000+ per month
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What monthly income are you believing for in the next 12 months?* This field is required.
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What's one thing you want to be true six months from now? Why does that matter so much to you?* This field is required.
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Where are you in your walk with God right now, and how do you want your faith to shape the way you build this business?* This field is required.
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What matters most to you in a coach? Why do you think Mia could be the right fit for you?* This field is required.
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Mia only takes on a handful of one on one clients at a time, and only women she is confident she can help. Private coaching with her starts at a $3,000 investment. With that in mind, are you in a position to invest in yourself right now?* This field is required.
Please Select
Please Select
Yes, I'm ready and able to invest.
I'm close, and I'd like to talk through the options.
Not right now, but I'd like to hear what's possible.
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Anything else you'd like to share?
Should be Empty: