Melanie Klein Private Coaching Application Question Title * 1. Tell me about yourself... Your First and Last Name Your Occupation Your Best Email Address Your Best Phone Number OK Question Title * 2. Rank in order, with # 1 being the most important thing in your life: 1 2 3 4 5 6 Family/Partner 1 2 3 4 5 6 Self-care + personal growth 1 2 3 4 5 6 Business/work 1 2 3 4 5 6 Health 1 2 3 4 5 6 Spiritual Growth 1 2 3 4 5 6 Travel + adventure OK Question Title * 3. Describe your relationship to your body: OK Question Title * 4. Rate your level of confidence, with 5 hearts being the most confident. OK Question Title * 5. What self-improvement tools or practices have you used or tried up to this point? What has worked and what has not worked? Why do you think that is? OK Question Title * 6. What is your biggest daily obstacle or challenge? OK Question Title * 7. What is your ideal vision for yourself in the next 6 -12 months? OK Question Title * 8. Rate your level of happiness on the smile scale, with 5 smiles being the most happy. OK Question Title * 9. Rate your desire/commitment to change, with 5 stars being the highest. OK Question Title * 10. On a scale of 1 - 10, how ready are you to invest and do the work with 10 being the highest? 1 10 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 11. Why do you believe working with a coach will help you at this point in your life? OK DONE