check

Private Coaching Intake Form

Thank you for your interest in a Private Coaching Container.

These are some of my favourite containers to experience with clients. 

All of my private clients are unique and our containers reflect that. My certifications and skills as a Coach allow me to hold space for a variety of different topics. From money mindset and business excellence to confidence building, boundaries and emotional intelligence, we can cover it all. 

Private coaching containers include a private client portal for replays and resources, integration tasks and weekly or biweekly zoom calls and more! 

Please take some time to complete this form so that I can better understand where you are currently and what you are desiring to achieve through a container like this! 

Once completed, I will reach out to you within 48 hours so that we can officially 'meet' for a one-on-one call! 

Thank you.

 

 

Start

Question 1 of 14

First and Last Name: 

 

Question 2 of 14

Email:

Question 3 of 14

What is your phone number to contact you? Best time to call?

Question 4 of 14

What is your full birthdate? MM/ DD/ YR

(We will use this to teach you about your Human Design!)

Question 5 of 14

Where were you born?

County, City, State:

EXACT time you were born?

(please include AM or PM)

Time:

(We will use this to teach you about your Human Design!)

Question 6 of 14

From the items below, where are you feeling most called to receive private coaching?

(Select all that apply)
A

Creating Clarity In Your Life

B

Communication Skills/ Speaking Your Truth

C

Emotional Intelligence- Understand Your Emotions/ Process Emotions

D

Healthy Boundaries

E

Leadership Skills/ Recruit Team Members/ Team Development

F

Money Management/ Money Mindset

G

Next Career Steps/ Career Change

H

Professionalism/ Work Ethics

I

Retirement/ Exit Strategy

J

Self Care / Self Love Strategies

K

Self Confidence

L

Social Media Skills

M

Strengthen Relationships (friends, family, partners, business partners)

N

Time Management (Work/Life Harmony)

O

Human Design- Tell Me More!

P

All-Inclusive Women's Retreat- Tell Me More!

Q

Reiki Healing Session- Tell Me More!

R

Silvers Healing Session- Tell Me More!

Question 7 of 14

Please share any other topics you would like to address during our coaching sessions and any details you would like for me to know. 

Question 8 of 14

What do you currently feel are your greatest strengths in life? in your business?

Question 9 of 14

What do you currently feel are your greatest challenges in life? in your business?

Question 10 of 14

If you could wave your magic wand, what would success look like from your coaching with me?

Question 11 of 14

These coaching containers are a minimum of 6 months.

 

Please indicate which container you are feeling more aligned with;

A

2 Sessions Per Month (60 Minutes Each) = $413 Per Month.

B

Weekly Sessions (60 Minutes Each) = $610 Per Month.

Question 12 of 14

Do you have any questions for me?

Question 13 of 14

Who can I thank for referring you to me?

Question 14 of 14

Are you interested in attending an upcoming Women's Retreat in Sedona, Arizona in 2025?

 

A

I would LOVE to hear more about this! Please send me more info!

B

Not right now, thank you.

Confirm and Submit