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

City & State:


Cell number:

Marital Status:


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?

Thanks for completing this typeform
Now create your own — it's free, easy, & beautiful
Create a <strong>typeform</strong>
Powered by Typeform