The first step to working with me is to fill out your contact information and the questions that follow to apply for a complimentary one-on-one Discovery session.

What will you learn? 

We’ll unveil what is working, what’s not working, and some blind spots that might be holding you back from becoming you true and successful you.  You’ll walk away with at least two to three actionable steps you can take and learn a lot more about how you can move your goals forward.  Plus, you’ll get a free gift after the session as a little “thank you” from me.

Why is this form so important?

These spots are limited and for good reason: I want to make sure I give each person I speak with my undivided attention just as I do for my clients.  What happens if we aren’t a good fit? I’ll provide recommendations for other resources that might be able to help you (if you’re open). Finally, I respect your time and mine.  Answering the questions below clarifies whether we’re the right match for each other and helps us make the most of our time together.


Your Name (required)

Your Email (required)

Phone Number

Website Site URL

Are you currently employed? Please explain: where, how long, full or part time?

What do you want to focus on, personally, in coaching?

My greatest strength, gift or talent is...

My greatest weakness is...

What I want more of in my life is...

What holds me back the most is...

The people most important to me are...

My friends would describe me as...

My 5 greatest values are...


1. Personal Happiness

2. Career Satisfaction

3. Health

4. Main Relationship

5. Friendships

6. Recreation

7. Personal Finances

8. Sense of Purpose

9. Spiritual Life

What I enjoy doing most is...

The most important thing in life for me is...

My biggest dreams (however “impractical”) are....

The main thing I want out of coaching is...

What I most want to create is...

What I think is in the way of creating that or would make it challenging to accomplish these objectives...

Have you ever worked with a coach? Please tell me about those experiences, if you was it, what did you think, what did you accomplish, etc.?

Would you have the unconditional support of a spouse, partner, or significant other if you were to embark on a coaching journey?

At the end of our time together, what three things would you be ecstatically happy about achieving?

What has stood in the way of your achieving these things on your own?

What’s one “breakthrough” or “a-ha” you’ve had thus far, just from the process of answering these questions?

On a scale of 1 to 10, how ready are you to invest a reasonable amount of time, energy, and money in order to create or build amazing goals and bring them into reality?

Anything else you’d like to add?

To prove you're not a robot


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