Kendra Dahlstrom Professional Success Coaching

First Name

Last Name

Email Address *

Phone Number

Skype ID (if outside the U.S.)

Address (for a surprise mailing)

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

We will keep it private.

What do you want to achieve in the next 90 days? *

[Start with what you want to solve, what you want *removed* from your life (a feeling, emotion, habit, or situation), and/or what you'd like to accomplish]. List 1-3.

What's the #1 reason you aren't doing it now?

[What's in your way or stopping you. If you don't know, it's okay to say that too.]

What is it *costing* you to not do it?

[Can be in the form of money (Sales, clients), or relationships, personal fulfillment.]

How is it impacting who you'd like to be?

How does all of this impact how you feel daily?

[Look at everything you've written so far, then write your answer.]

Daily stress level (scale of 1-10)

[10 is the highest]

What have you invested to date to solve this?

Up to $5,000$5,000 to $15,000Over $15,000

[List books, courses, coaches, retreats, therapy, etc.]

Given the above, what are you willing to invest?

$300 to $4,000 (I am not ready to invest right much right now.)Up to $15,000 (I am very serious about change)

[Look at all your answers above - what it's costing you, what the impact is, your daily stress level, your past investments.]

Tell me why you are committed *

When are you looking to begin? *

Have you ever been hired a coach before?

YesNo

Application for Success Coaching with Kendra Dahlstrom