I want to set you up for success, and make sure we're a good fit. So this application form will help guide our discovery call. The purpose of the discovery call is to determine if we're a good fit for one-on-one or group coaching.
Coaching application form
A bit more information about you
I have your name and email address already, but it will be helpful to also have the following information.
01. What timezone you live in?
{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Please type in your Country, state & timezone. "}
02. What is your mobile phone number?
Just in case we can't connect via online Zoom call, please provide your mobile (cell) number including country code and area code.
{"type":"textarea","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Include country code, area code & cell/mobile number."}
03. Tell me a bit about yourself
{"type":"textarea","name":"__generic3","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"Describe the things you have tried already to make this change."}
04. Are you ready to invest in yourself?
One-on-one coaching starts at AU$500 per month
{"type":"radio","name":"__generic4","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"Yes, if we're the right fit\nI'm on the fence, I need a little convincing!\nI need a lot more information first"}
Challenges
06. What exactly are you struggling with?
{"type":"textarea","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
07. How long have you been struggling with the problem?
{"type":"textarea","name":"__generic8","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Satisfaction scale
08. If you had to rate your satisfaction with your life right now, what rating would you give if 10 was completely satisfied?
{"type":"radio","name":"__generic7","width":10,"value":"","size":"Small","validation":"C1","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}
09. Where do you want to be?
{"type":"radio","name":"__generic9","width":10,"value":"","size":"Small","validation":"C1","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}
10. How might you move up the scale?
{"type":"textarea","name":"__generic10","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Coaching Journey
11. Have you had a coach before?
{"type":"radio","name":"__generic11","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}
12. What do you hope to achieve through the coaching process?
{"type":"textarea","name":"__generic12","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
How committed are you to making a change?
1 = I'm thinking about making a start; 5 = I'm all in and prepared to do the work.
{"type":"radio","name":"__generic13","width":20,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5"}
client 15/7/25
