Take your time and answer these questions as best you can.
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Name:

 
City & State:

 
Age:

 
Cell number:

 
Marital Status:

 
Children?

     
 
Why are you interested in Life Coaching? specifically, my BodyMind Program?

 
What is the biggest frustration/pain you are currently experiencing?

 
How does this frustration/pain impact your daily life?

 
If this frustration/pain was no longer an issue, how would that positively benefit your daily life?  What would that look like?

 
Why is solving this frustration/pain important to you?

 
On a scale of 1-10, how committed are you to solving this frustration/pain in your life?

 
What other programs/books/treatments/resources have you already tried to solve this frustration/pain?  What has worked?  What hasn't worked?

 
What are your TOP 3 SHORT TERM goals you would like to achieve over the next 3-6 months?

 
What are your fears that hold you back from living your dream life?

 
What motivates you?

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