Peak Performance Humans Performance Coaching Performance Coaching Application Please complete this form- We are excited to learn how we can assist with improving your performance! OK Question Title * 1. Your Contact Information Name Occupation Age Marital Status City/Town Country Email Phone OK Question Title * 2. Rate yourself on a scale of 1-10 in each of the following areas. 1 being, that you have NOT made any progress inthis area and 10 being that you are RIGHT where you think you should be by this stage in your life? 1 2 3 4 5 6 7 8 9 10 Health Health 1 Health 2 Health 3 Health 4 Health 5 Health 6 Health 7 Health 8 Health 9 Health 10 Finance Finance 1 Finance 2 Finance 3 Finance 4 Finance 5 Finance 6 Finance 7 Finance 8 Finance 9 Finance 10 Career Career 1 Career 2 Career 3 Career 4 Career 5 Career 6 Career 7 Career 8 Career 9 Career 10 Relationship Relationship 1 Relationship 2 Relationship 3 Relationship 4 Relationship 5 Relationship 6 Relationship 7 Relationship 8 Relationship 9 Relationship 10 Emotions Emotions 1 Emotions 2 Emotions 3 Emotions 4 Emotions 5 Emotions 6 Emotions 7 Emotions 8 Emotions 9 Emotions 10 Time Management Time Management 1 Time Management 2 Time Management 3 Time Management 4 Time Management 5 Time Management 6 Time Management 7 Time Management 8 Time Management 9 Time Management 10 OK Question Title * 3. Pick 3 of the above categories that you want to change and/or improve. In the space below, explain what would have to happen in order to take each of these 3 areas to a level “10” experience? 1st Category Change 2nd Category Change 3rd Category Change OK Question Title * 4. What is the PAY OFF for achieving these goals? How is your new life going to be different? What is the upside or the reward for following through on these goals? 1st Category Rewards 2nd Category Rewards 3rd Category Rewards OK Question Title * 5. What beliefs, fears and/or patterns of behaviors have prevented you from already achieving these goals? 1st Belief or Fear 2nd Belief or Fear 3rd Belief or Fear OK Question Title * 6. What is the COST or the Negative Consequences for not following through? What is your life going to be like if you continue to buy into your excuses, patterns and fears? 1st Consequence 2nd Consequence 3rd Consequence OK Question Title * 7. Why are you a good candidate for our coaching and how do you think you will be able to benefit from a coaching program like this? 1st Reason/Benefit 2nd Reason/Benefit 3rd Reason/Benefit OK Question Title * 8. What type of coaching are you looking for? Performance Accountability TIme Management Vision/Purpose Relationship Health Finances Other (Please Specify) OK Question Title * 9. How did you learn about Peak Performance Humans and/or coaching? OK Question Title * 10. Please click "DONE" below to submit your answers.As soon as we receive your completed form a member of ourteam will reach out to help find a date/time for you to have yourperformance strategy session!Have a wonderful day!To your success,The Team at Peak Performance Humans OK DONE