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* 1. Please provide me with your contact information.

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* 2. Please tell me a little bit about yourself and why you are interested in working with me.

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* 3. What 3 goals (health, life and/or business) do you want to achieve over the next 3, 6 or 12 months?

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* 4. What is your #1 health complaint? How long has it been going on?

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* 5. What are your next health complaints? How long have they been bothering you?

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* 6. What do you feel you need most right now?

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* 7. What have been your 1-2 greatest successes to date?

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* 8. What is the greatest challenge you have had to overcome? 

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* 9. Please rank the below statements in order from 1-10 (10 being the most important) of what you hope to achieve throughout your 1:1 coaching sessions.

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* 10. On a scale of 1-10, how motivated are you mentally and monetarily (minimum of $500/session) to working with a life coach? (1 being the least, 10 being fully-committed)

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* 11. Please provide any additional information you would like to share before submitting your application.

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