Background

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.

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* 1. I found out about this program via:

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* 2. My email address is

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* 3. My name is:

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* 4. Desired Objective: The primary reason you desire coaching is to improve what area of your life?

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* 5. I have a real, priority goal I'd like to achieve within the next year

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* 6. My Goal is ....

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* 7. On a scale of 1 -10 my belief that I'm capable of achieving this goal is a ....

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* 8. On a scale of 1-10 my commitment to achieving this goal in the next year is a....

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* 9. Your current physical health is (scale 1-5, 5 being best)

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* 10. What has been the greatest highlight of your life so far?

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* 11. What is one of the lowest points of your life (optional- do not have to complete)

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* 12. What is your greatest talent/ability (from a professional/value standpoint)

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* 13. What would a best friend or parent brag about when they were talking about you

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* 14. List 3 of your best habits

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* 15. List 3 of your worst habits

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* 16. If i achieve my goal within the next year I will feel...

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* 17. If I do not achieve my goal in the next year I will feel....

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* 18. The reason I want to join the GET UNSTUCK Program is...

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* 19. I am interested in personalized, executive coaching from Martin and want to learn more.

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