Tell me about yourself...

I'd love to get to know you and your goals a bit better. Utilize the space below to tell me everything you think I need to know about you. Please take some time to rate the areas of your life so we can track your progress and know what to focus on. xoxo, Christina

Full Name *

Email *

Phone *

Who would you say you are without the label of Wife/Husband, Boss/Employee, Mom/Dad, Girlfriend/Boyfriend, Sister/Brother, etc?

Current Life Snapshot

Please rank the following:
10 = I’m completely satisfied and this area is not lacking attention – whoop!

0 = I’m not satisfied at all and this area is being completely neglected – oops!

Business & Career *

Not SatisfiedCompletely Satisfied

Money & Financial *

Not SatisfiedCompletely Satisfied

Health & Wellness *

Not SatisfiedCompletely Satisfied

Love & Romance *

Not SatisfiedCompletely Satisfied

Family & Friends *

Not SatisfiedCompletely Satisfied

Personal Growth *

Not SatisfiedCompletely Satisfied

Fun & Recreation *

Not SatisfiedCompletely Satisfied

Spirituality & Contribution *

Not SatisfiedCompletely Satisfied

Which 1–2 areas do you feel most called to focus on right now?

Business & Career

Money & Financial

Health & Wellness

Love & Romance

Family & Friends

Personal Growth

Fun & Recreation

Spirituality & Contribution

What would you most like to change or improve in your life over the next 6–12 months?

If we worked together, what would success look like for you?

What’s your biggest dream goal, even if it feels out of reach right now?

What do you feel is holding you back from living at the level you want?

What have you tried before (books, courses, coaching, therapy, etc.)? What worked, and what didn’t?

Is there a limiting belief or pattern that you notice yourself repeating?

Why are you interested in working with me specifically?

What qualities are you looking for in a coach?

Are you open to being challenged and held accountable?

Yes

No

Unsure

How ready are you to invest in yourself at this time?

Not ReadyReady

Preferred coaching format: (select all that apply)

1-on-1

Small Group

Online

In-Person

Availability

General Days/Times

AM

PM

Weekdays

Weekends

Preferred Days/Times:

Top 3 goals for the next 30 days: *

If there was one thing you wish you could say out loud but haven’t yet, what would it be?

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