Name *

First Name

Last Name

Phone

If you prefer text

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Have you ever worked with a coach before? *

Yes

No

Personal Mentors / Friends

What is your epic opportunity or challenge? *

Empty Nesting

Divorce

Breaking Old Habits/Patterns/Addictions

Feeling Stuck

Plotting a Big Goal

Career Change

Needing to Focus

Refining for Peace & Contentment

Personal Vision & Execution

Resetting for Midlife

Entering Retirement

Other Life Transitions

Other

What is your relationship with time? Do you adapt to change fast, slow, or you don't know?

Fast

Slow

Don't Know