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Private Coaching Intake Form

Thank you for your interest in a Private Coaching Container. These are some of my favourite containers to experience with clients. 

Please take some time to complete this form so that I can better understand where you are currently and what you are desiring to achieve through a container like this! 

Once completed, I will reach out to you within 48 hours so that we can officially 'meet' for a one-on-one call! 

Thank you.

 

 

Start

Question 1 of 15

First and Last Name: 

 

Question 2 of 15

Email:

Question 3 of 15

What is your phone number to contact you with? Best time to call?

Question 4 of 15

What is your full birthdate? MM/ DD/ YR

(We will use this to teach you about your Human Design!)

Question 5 of 15

Where were you born? EXACT time you were born? (please include AM or PM)

County, City, State:

Time:

(We will use this to teach you about your Human Design!)

Question 6 of 15

From the items below, where are you feeling most called to receive private coaching?

(Select all that apply)
A

Creating Clarity In Your Life

B

Communication Skills/ Speaking Your Truth

C

Emotional Intelligence- Understand Your Emotions/ Process Emotions

D

Healthy Boundaries

E

Leadership Skills/ Recruit Team Members/ Team Development

F

Money Management/ Money Mindset

G

Next Career Steps/ Career Change

H

Professionalism/ Work Ethics

I

Retirement/ Exit Strategy

J

Self Care Strategies

K

Self Confidence

L

Social Media Skills

M

Strengthen Relationships (friends, family, partners, business partners)

N

Time Management (Work/Life Harmony)

O

Human Design- Tell Me More!

P

All-Inclusive Women's Retreat- Tell Me More!

Q

Reiki Healing Session- Tell Me More!

R

Silvers Healing Session- Tell Me More!

Question 7 of 15

Please share any other topics you would like to address during our coaching sessions and any details you would like for me to know. 

Question 8 of 15

What do you currently feel are your greatest strengths in your life? in your business?

Question 9 of 15

What do you currently feel are your greatest challenges in your life? in your business?

Question 10 of 15

If you could wave your magic wand, what would success look like from your coaching with me?

Question 11 of 15

These coaching containers are a minimum of SIX MONTHS.

 

Please indicate which container you are feeling more aligned with;

A

2 Sessions Per Month (60 Minutes Each) = $366 Per Month.

B

Weekly Sessions (60 Minutes Each) = $610 Per Month.

Question 12 of 15

How would you feel most aligned with paying for these sessions?

A

Weekly Payments of $91.50 (two sessions per month) OR $152.50 (four sessions per month)

B

Bi-Weekly Payments of $183 (two sessions per month) OR $305 (four sessions per month)

C

Monthly Payments of $366 (two sessions per month) OR $610 (four sessions per month)

D

Pay In Full For The 6 Months *Special Bonus Price! $2,022 (two sessions per month) OR $3,444 (four sessions per month)

E

I'm not sure. Let's discuss my budget.

Question 13 of 15

Do you have any questions for me?

Question 14 of 15

Who can I thank for referring you to me?

Question 15 of 15

Are you interested in attending an upcoming Women's Retreat in Sedona, Arizona? September, October 2024?

 

A

I would LOVE to hear more about this! Please send me more info!

B

Not right now, thank you.

Confirm and Submit