The Next Step

If you are serious about making changes in your business or your life, I offer a complimentary consultation for 20-30 minutes by telephone or in person. This form will help us see if we're a good fit for each other, and to ensure coaching will make a significant impact in your personal or business life.

I cover telephone charges - both local and international - for all my coaching sessions including the complimentary consultation. If we're a good match, we'll set up an ongoing coaching structure. This takes about 5 minutes, and you'll leave the call with actions to take!

Even if we're not a match, my commitment is to give you a sense of what coaching feels like, and to help you move forward in an area that is important to you. I'm also happy to refer you to other coaches, Employment Specialists, etc. if they are a better fit. I find some people are excited and others are a bit nervous. Wherever you are is perfect. And, if you already have my cell number just pick up the phone and CALL me. :) For everyone else...

Serious Inquiries Only
Please fill in the form to Request a Connection with me:

1) a) For each of the following life areas, how would you rate your life out of 10 (10 being you can't imagine it could possibly be any better)?






Peace & Confidence

Own Business

Learning & Growth

b) Given these scores, what two areas are you willing to improve over the next 6 months to make the biggest difference to your life? (Maximum Two)






Peace & Confidence

Own Business

Learning & Growth

2) What is one goal (target) you could achieve by 6 months from now that would make a BIG difference to your life?

3) If you could have more of ONE thing in your life right now, what would it be?

4) What three things are you most tolerating or putting up with in your life?




Which of these are you ready to handle?

5) Please write down one thing you would like to have or achieve, but are not clear if or how you can have it?

6) Assuming all human beings have some way of holding back or sabotaging their life, which would be your favourite method?



Arrogant/ being right

Acting as a 'Lone Ranger'


Not saying "No"

Controlling life /people

Not saying "Yes"

Following secondary goals
(i.e. goals that won't ultimately make me happy)

Not always telling absolute truth



7) If you had a coach, what would you probably get from the coaching that would be most valuable to you? (3 maximum)







Sounding Board

Ideas/ Strategies





8) How coachable do you suspect you are? (open to input and feedback; comfortable in partnership; ready to make changes)



I'm trouble

Required Fields Marked with *

10) Should we decide to work together, how affordable do you feel the coaching investment is for you?* ( typ. $6,000 to $50,000 commitment)


Reasonably, esspecially with results

A stretch, but OK if I get results

I don't see how I could justify it




11) If we both agreed coaching is a good move for you right now, what will it take for you to come up with an initial coaching fee of $6,000? *

Immediately available

1 month

3 months

6 months or more


I have read the section on who you work with :*

I have read and understand that while I may choose to commit to a extended coaching agreement, fees are paid up front and are non-refundable.

If after this complimentary session we decided to work together, enter preferred start date*

Within the next 10 days

Within the next 30 days

Within the next 3 months

Do you require anyone else's agreement before setting up a one year coaching structure for yourself?*

No, I can make that decision alone (or I have my partner's and/or company's full support)

Yes, I would want to get the agreement of my partner or company first

Required Fields Marked with *

First Name*

Last Name*






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