Coaching for Men 40+ | Reclaim Your Strength & Purpose

First off, thank yourself for taking action and reclaiming your life. Your journey starts here.

Take 5 minutes to answer the questions as accurately as possible. This will help assure you get the most out of our clarity call.

Once the questions have been completed you will be redirect to schedule a call with me

First Name

Last Name

Email *

Phone *

On a scale from 1 to 10 How SATISFIED are you with your overall life? *

1 - Not Satisfied
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10 - Super Satisfied
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On a scale from 1 to 10 How much FUN are you having in your life? *

1- NO Fun
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10 - Life is Super Fun
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On a scale from 1 to 10 How overwhelmed do you feel by your current commitments? *

1- Overwhelmed
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10 - Untroubled
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What are the top three areas in your life you feel need the most improvement (e.g., mindset, relationships, fitness, career, finances, faith, confidence, purpose)? *

What is the biggest challenge you're currently facing in life? *

Are there any other addictions or unhealthy habits you are currently struggling with? e.g. Alcohol, Drugs, Porn, Overeating etc *

What habits or limiting beliefs do you feel are holding you back the most? *

From a scale from 1 to 10 how is your relationship with your significant other? *

0- Not in a relationship
1 - Relationship is Bad
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10 - Relationship is Excellent
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What would you like to improve in the relationship with your significant other? *

From a scale from 1 to 10 how is your relationship with your children? *

0 - I have no children
1- Relationships is bad
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10 -Our relationship is Excellent
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What would you like to improve in your relationship with your Children? *

On a scale from 1 to 7 How do you feel about your overall health and fitness? *

1 - Over weight and don't workout
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7 - Fit and Healthy
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What areas of your health or fitness do you feel could benefit from additional attention or support? *

Are You Unemployed, An Employee, A Business Owner Or Entrepreneur? *

Unemployed

Employed

Business Owner

Entrepreneur

If anything was possible, what would you change about your career or business? *

Have you worked with a coach or mentor before? If so, what was your experience like? *

What specifically do you hope to achieve from coaching? *

Coaching requires commitment are you willing to do the work, even when it’s uncomfortable? *

Yes

No

On a scale from 1 to 5, How Ready Are You To Take ACTION To Make The Changes In Your Habits, Choices and Life? *

1 - NOT READY TO TAKE ACTION

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5 - I'M READY TO TAKE ACTION

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