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251 Woodford St.,
Portland, ME 04103
Phone: (207) 712-0015
Email: john@activatesuccess.org

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Initial Consultation Form

I look forward to speaking with you about your interest in my coaching and/or consultation services. I provide a no-charge initial consultation to determine your needs and to ensure that I have the skills to be of help to you. Please be aware that this initial meeting is not coaching and will not include any feedback or work on your problem.

Name

Email Address

Please briefly describe your reason(s) for seeking out coaching? Be as specific as you can be. What do you want to change? How would you best describe your needs? What do you want from coaching?

Have you previously been coached? What worked well for you? What did not?

On a scale of 1 (not at all motivated) to 10 (highly motivated), how motivated are you to change your situation?

Thank you for taking the time to complete this. I look forward to speaking with you!

Hire Me to Speak

I look forward to speaking with you about your interest in hiring me to provide a keynote address or other engaging presentation at your next event. Please complete the form below if you would like to provide me with some initial information about the goals for the event. If you prefer, you can also email me directly at: john@activatesuccess.org.

Name(Required)

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Tell me about your event(Required)

How may I add value to your meeting? What topic(s)are of most interest to you? (e.g. wellness, stress management, diversity, incivility, difficulties with change, other?). I look forward to learning about your event.(Required)

Thank you for taking the time to complete this questionnaire! Your answers will help me to make the most of our time together.

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