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Preparation for Appointment

Preperation form to be completed prior to call. 

Click the button below to start.

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Question 1 of 12

What is your first and last name?

Question 2 of 12

What is your email and mobile no.?

Question 3 of 12

How did you hear about me and my 12 week program?

Question 4 of 12

Would you prefer zoom or phone? 

A

Zoom

B

Phone

Question 5 of 12

What is currently your biggest frustration and challenge? 

(This questions relates to not only your child but family life, your own health etc..)

Question 6 of 12

What are you hoping to achieve or get out of the 12 week program? 

Question 7 of 12

Are there any obstacles to you reaching this goal? 

Question 8 of 12

Briefly describe your current lifestyle i.e work, number of kids, committments, additional challenges etc...

Question 9 of 12

Right now.....

A

I have financial resources (or funding) available to build my capacity and invest in myself, my child & my family

B

I don't have the financial resources at this point

Question 10 of 12

If someone advised me to spend $1000-$2000 on a coaching program specific to my caring role I would....

A

Know that it would be a good investment in myself, my child & my family

B

Be a little cautious and want to learn more

C

Avoid at all costs because I need/want to do things as cheaply as possible

Question 11 of 12

I believe working with an experienced and qualified professional is a worthwhile investment

A

Yes

B

No

Question 12 of 12

I will call you at a time of your choice. Please commit to your appointment time by typing "Yes. I will answer my phone/zoom for our appointment" :) 

Confirm and Submit