Please share a little information about your background, current situation and goals/objectives desired from working with me. Note: this is entirely confidential. Nobody else will see this.
1. I found out about this program via:
2. My email address is
3. My name is:
4. Desired Objective: The primary reason you desire coaching is to improve what area of your life?
5. I have a real, priority goal I'd like to achieve within the next year
6. My Goal is ....
7. On a scale of 1 -10 my belief that I'm capable of achieving this goal is a ....
8. On a scale of 1-10 my commitment to achieving this goal in the next year is a....
9. Your current physical health is (scale 1-5, 5 being best)
10. What has been the greatest highlight of your life so far?
11. What is one of the lowest points of your life (optional- do not have to complete)
12. What is your greatest talent/ability (from a professional/value standpoint)
13. What would a best friend or parent brag about when they were talking about you
14. List 3 of your best habits
15. List 3 of your worst habits
16. If i achieve my goal within the next year I will feel...
17. If I do not achieve my goal in the next year I will feel....
18. The reason I want to join the GET UNSTUCK Program is...
19. I am interested in personalized, executive coaching from Martin and want to learn more.
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