1:1 Leadership and Mindset Mastery Program
Questionaire
Client Information
Name
First Name
Last Name
Address
Phone Number
-
Area Code
Phone Number
E-mail
On a scale of 1-10 how do you feel your overall mindset is right now?
On a scale of 1-10 how would you rate your overall business performance?
On a scale of 1-10 how would you rate your overall interpersonal relationships?
Please tell me what your ultimate goal in working with me as your coach. What will your life, goals, mindset and business feel and look like?
Please describe your current day to day schedule? What are your routines, habits, health, self care, and professional day to day routines?
Why now? Why is this the right time for you to reach your goals?
Please tell me a little bit about your current family or close community support system?
Are you ready to fully commit to reaching your goals and empower yourself committed action?
Yes
No
80% ready
Please tell me about any self sabotaging behaviors you are aware of.
Pease tell me the number one priority you have with your leadership and mindset right now?
Is there anything else you would like me to know?
Who is your emergency contact and phone number?
Please schedule your first appointment on Friday Aug 18th or Saturday Aug 19th below. Location will be Boise and I will email you the address once you schedule.
Appointment
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