🟦 SECTION 1: Your Information

Full Name

Email *

Phone *

Where are you Located? *

🟨 SECTION 2: Your Situation Right Now

What made you reach out for coaching?

(Be honest. I don’t need polished answers — I need the truth.)

What are the top 3 challenges you’re dealing with right now?

What have you already tried to fix these problems?

What happens if nothing changes in the next 6–12 months?

(This tells me how serious this is for you.)

🟥 SECTION 3: Your Goals

What do you want to be true about your life or business 6 months from now?

What does “alignment” look like to you personally?

What do you hope to get from working with me?

🟩 SECTION 4: Commitment & Fit

Coaching with me requires honesty, responsibility, and doing the work. Are you willing to show up fully?

Yes

I think so, but I’m unsure

How ready are you to invest in yourself right now?

I’m ready now

I'm preparing for it

I want help but I'm not ready to commit

If I'm being honest, I don't know

(This isn’t for judgment — it helps me know where you are mentally.)

If we’re a fit, which type of support are you leaning toward?

Personal Coaching

Business & Leadership Coaching

Hybrid - Both Personal and Business

Not sure yet

🟪 SECTION 5: Optional Background

Anything else you want me to know before we talk?

🟫 FINAL SECTION: Consent

By checking this box, I consent to receive appointment reminders, confirmations, and account-related updates. Message frequency varies. Standard message and data rates may apply. Reply STOP to opt-out.

By checking this box, I consent to receive coaching insights, updates, and occasional offers. Message frequency varies. Standard message and data rates may apply. Reply STOP to opt-out.

*Privacy Matters. Here’s the Deal.

Anything you share with me stays between us. Your information won’t be sold, shared, or handed off to anyone — ever. I only use your details to contact you, review your application, and provide the support you asked for. No spam. No shady crap. No surprises. Just respect, confidentiality, and professionalism. If you ever want your information deleted, just let me know and it’s gone.