Coaching Screening

First Name

Last Name

Email Address

Occupation

What is your wellness goal?

What is the time frame to achieve your goal?

Do you have a short term goal that leads you to obtaining your overall goal? If so, when do you want to achieve this goal?

How committed are you to achieving results on a scale of 1-10? *

What is the payoff for achieving these goals? What is the upside or the reward for the following through on these goals?

What patterns or behaviors have prevented you from already achieving these goals?

What is the cost or negative consequences for not following through?

Why are you a good candidate for our coaching / training program?

Additional thoughts/comments: