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Waiting List - Free Strategy Session Application
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1.
First Name:
(Required.)
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2.
Last Name:
(Required.)
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3.
Email (please use the same email from scheduling):
(Required.)
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4.
Phone Number:
(Required.)
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5.
Are you more interested in changing something in your work life or in your personal life or are both equally important right now?
(Required.)
Personal
Work
Both
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6.
What specifically are you looking to change in your life in the next 2 - 3 months?
(Required.)
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7.
What is the #1 thing holding you back, right now, from being the person you want to be or reaching your goals?
(Required.)
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8.
Impact, Part 1 --> Review what you wrote is holding you back. How is this obstacle impacting how you FEEL on a daily basis?
(Required.)
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9.
Impact, Part 2 --> Review what you wrote is holding you back. How is this challenge impacting your relationships with friends, family, employees, or colleagues?
(Required.)
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10.
Impact, Part 3 --> Review what you wrote is holding you back. How is this roadblock impacting your work performance or the amount of revenue you're generating? (Is it COSTING you money?) [Put n/a if this doesn't apply to you.]
(Required.)
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11.
On a scale of 1 - 10, what is your average daily stress level?
(Required.)
1
2
3
4
5
6
7
8
9
10
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12.
How much control do you have over your own environment? (For example, if it was absolutely necessary*, would you be able to have any impact on how much you sleep, when you work, your relationships, etc?)
(Required.)
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13.
What have you invested—think time, energy, money—to try and fix your challenges thus far? (Books? Groups? Therapy? Programs? Retreats? Coaching? Courses? Mentors? Supplements?)
(Required.)
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14.
If we decide to work together, when would you be looking to begin?
(Required.)
15.
Roughly how much time have you invested in working on your challenges?
16.
Roughly how much money have you invested in trying to address these challenges in the past?
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17.
Where did you hear about us?
(Required.)
18.
This meeting with Shelly is at no cost. However, if you and Shelly decide you are a fit, she'll invite you to work with her further.
Are you in a position to invest in your personal growth right now?
Yes
No
Current Progress,
0 of 18 answered