Incredible Factor University Student Background Form
Name
*
First Name
Last Name
Email
*
example@example.com
Assistant's Name
First Name
Last Name
Assistant's Email
example@example.com
Birthday
*
Business Legal Entity
*
EIN Number
*
Who Referred You?
*
Write N/A if not applicable
Tell us about your family (married? children?) and any significant relationships
*
Emergency Contact Name & Relationship
*
ie. John Smith - Husband
Emergency Contact Phone Number
*
They will only be contacted in case of emergency
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All coaching looks inward first. What in you (in your core beliefs, thoughts, behaviors, etc,) may require adjustment to help you to live your best life: be honest, otherwise coaching will not work.
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What are the three biggest changes you want to make in the next month? Three months?
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Share five facts about your background – anything that will help me understand you and allow me to better support you.
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What are your top five accomplishments thus far in your life?
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What habits, activities, or thought processes do you believe need to be dropped, simplified or let go of inorder to truly, quickly move forward?
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The three things that I like most about my life/situation are:
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If I could change three things about my life/situation, they would be:
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On a scale from 1 to 10, 10 being incredible, my life fulfillment quotient is _________.
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1
2
3
4
5
6
7
8
9
10
Incredible
1 is , 10 is Incredible
Please explain why
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The one thing I would like most to accomplish (but haven’t yet) is:
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The one thing I wish I could change in the short-term is:
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What types of books do you enjoy:
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Last book you read:
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Please list the magazines you read and blogs you currently are subscribed to:
*
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Favorite Things
Favorite Color
Favorite Food/Snacks
Favorite Fruit
Favorite Fruit
Favorite Flower
Favorite Indulgence (you'd never buy this for yourself)
Shoe Size
T Shirt Size
*
Favorite Restaurant
Favorite Spa
Favorite Accessory
Favorite Hobby
Any Allergies, Dietary Restrictions, or Fragrance Sensitivities?
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