Mini-Questionnaire for Private Coaching

Please use the form below to get started with Private Coaching.

This information will help me assess if we are a fit and if I can help you. So we don’t waste anyone’s time, I have a some specific criteria that has to be met that is the first start to know if we can work together.


Complete this form and we’ll get back to you.


Do realize we receive many inquiries, so please be patient. But know we ALWAYS respond.

Note: A limited number of individual sessions are available each month so please complete the Mini-Questionnaire as quickly as possible so you can get on our schedule.


Your Name (required)

Your Email (required)

Brief description of your education and background: (Where did you go to school, what degree, and what type of work experience do you have, in general?)

Please describe your Business, Company or Department in detail: What industry do you work in? What products does your company sell? where?

How many employees do you manage besides yourself?

How long have you worked at or owned your company?

Please provide us with as much of an Overview of your Business as you can:
What has been your biggest challenge with your work life, career, or your business?

How do you feel your work life or business could be improved?

What part of your work life or business do you feel is suffering the most (time management, skills, staff, customer service, etc.)?

What are the 3 biggest problems you’re having in your area of work?

What are the areas where you would like to see improvements in your work life, career or business?

What are some of your goals for your company/department? Short-term? Long-Term?

How did you hear about me?