Client Exploration Application
*Everything you share here is private and confidential. Please share openly and freely.


Filling out this application does not guarantee a spot to work with me. I will review your application, and if I feel it's a good fit, you will hear from me within 48-72 hours to schedule a free consultation. From there we will decide on next steps.

Sending a virtual high five!
Amber
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Name (first and last) *
Phone Number *
E-mail *
Address (at least country you reside in) *
Website(s)
Birthday (include time and location if you know it) *
Have you worked with a coach before? If yes, why? *
Why are you drawn to work with me? *
How do you currently answer the question 'what do you do?' Does that feel aligned for you? *
Where would you like to see yourself personally and professionally 3 years from now? Paint me a picture of what living intentionally would look like for you at this phase in your life? *
What are you most challenged with right now? What do you desire support with most? Please be as clear as possible here. *
If there was just one powerful thing you could get out of our time together, what would that be? Again, please be as specific as possible (for example, if clarity is your answer, I'd like to know what specific clarity you'd walk away with). *
What is your #1 goal you hope to achieve working with me? *
What do you consider are your greatest character qualities? Why will you be a good candidate for coaching? *
on a scale of 1-10, how committed are you to creating the change you desire? *
Do you have any questions for me?
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Agreement: {If we are to work together}*PERSONAL RESPONSIBILITY AND RELEASE OF BUSINESS AND HEALTH CARE RELATED CLAIMS* The Client acknowledges that the Client takes full responsibility for the Client’s business, life and well-being, and all decisions made during and after the time he/she woks with the Coach. All recommendations or advice are recommendations only, and at all times the Client has the choice to disregard recommendations. The Client releases the Coach, his/her heirs, executors, administrators and assigns, its officers, directors, shareholders, employees, teachers, lecturers, agents, coaches and staff (collectively, the Releasees) from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law, admiralty or equity, which against the Releasees, the Client ever had, now has or will have in the future against the Releasees, arising from the Client’s past or future participation in, or otherwise with respect to, the coaching relationship. If the terms of this Agreement are acceptable, please mark "I Agree" below, to signify acceptance. By doing so, you acknowledge that: (I) the above is meant to have legal significance and is regarded as legally binding and, (II) you understand, accept and agree to abide by the terms hereof. *
Today's Date *
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Signature (write first and last name again) *
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