New Client Application | The Naked Life Coach™

Name *

First

Last

Email *

Phone Number *

Skype ID (Optional)

(Required for any calls outside the USA)

Street Address *

City, State, Zip/Postal Code *

Where did you first hear about me? *

Personal Referral
Internet Search
Social Media

If someone personally referred you, please tell me their name. If it was an internet search, what were you looking for? *

In what areas do you seek coaching? *

Check all that apply.

What do you want to achieve through coaching? Be specific and detailed, and list all your goals. *

Please describe the all goal(s) you are working towards.

Be 100% honest... What has stopped you from achieving these goals, so far? Again, be specific and detailed, and list all your challenges. *

Please describe all the challenges you are facing or whatever has held you back.

What would be the most important criteria for your success as we work together? (select all that apply) *

Are there any other criteria for your success that aren't on the above list?

(optional)

What has motivated you to get coaching now, and why choose The Naked Life Coach? *

What is happening in your life currently, and how can I help?

What types of products and/or services will fit your needs? *

Check all that apply.

How often would you like to receive coaching? *

Non-sexual nudity can provide several benefits to the life-change process, however, it is always optional and to your comfort level. Would you prefer nude or clothed sessions? *

Nude
Clothing Optional (I'll decide during the session)
Clothing On
Clothing Required (participants under 18 years of age attending)
Not Applicable (I prefer video training/books/phone/IM/email)

Do you have any additional questions or comments?

It is important that you realize that some things may be resolved quite quickly and easily during coaching, with the techniques at my disposal, while other things may require quite a bit of time and energy on your part. I offer high-ticket, high result, short term programs to help you achieve your goals and dreams as quickly as possible. Are you willing to commit to putting in that time, energy, and money, on your own behalf?

Yes! I'm willing to make that commitment to myself.
Maybe. I have questions.
No, I can't commit at this time.
Other, please specify below...

If the answer above was maybe, no, or other, please let me know what would stop you from committing to your personal development?

Are you able to afford cash for a high-ticket coaching program, or if not, are you willing to use credit? *

Yes
No

(Only if working 1-on-1 with me to help you permanently improve your life made sense and you wanted to move forward. of course. Answering yes here does not guarantee that we will be a good fit to work together.)

Does your spouse or significant other fully support you? (Meaning they will give you a thumbs up on whatever you decide) *

Yes
No
Not Applicable

How would you like me to contact you? *

Phone Call
Text Message
Email

What are the best days & times to reach you? Note: please specify your time zone as well. *

* Within my business hours: M-Th 3-9 PM, Fri 3-6 PM MST-AZ (GMT-0:700)