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Clarity Call Application

Name

Surname

Email address

Cell number

Location

Age

Age
A
B
C
D
E
F
G
H

Choose which best describes

Choose which best describes
A
B
C
D
E
F

If you selected other please specify below. (If this is left blank please add N/A)

Please be specific in your answers. Rather give me to much information than to little.

Imagine you and I are sitting in a coffee shop a year from now having a chat. Tell me what would need to happen in your life both personally and/or professionally for you to feel like you were happy with the year that you just had?

Why do you want the above-mentioned?

Why is this important to you?

What do you feel has been standing in your way and holding you back from achieving this in your life?

Why do you feel that you are ready for change?

What kind of support from a coach would be the most helpful for you to receive now to take you to a higher level in your life and in your career/ business?

Is this something you want to work on now or later?

Which most applies to you?

Which most applies to you?
A
B
C
D

How committed are you to taking small steps and learning new skills to build a life where you are fulfilling your full potential?

How committed are you to taking small steps and learning new skills to build a life where you are fulfilling your full potential?

Are you currently working with a coach or have you recently done a course or will be participating in a course in the near future? Please provide details if yes

Do you have the resources to make the most of an opportunity to turn your anxiety into your greatest source of power?

Do you have the resources to make the most of an opportunity to turn your anxiety into your greatest source of power?
A
B
C

Is there anything you would like to tell me? Please specify it here.

Do you give permission for communication to be sent to your WhatsApp number/ e-mail address?

Do you give permission for communication to be sent to your WhatsApp number/ e-mail address?
A
B

* If you answered no we will not be able to send you further correspondence