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Screening Form
1. Basic Context | Name
(Required)
First
Last
Email
Current Proffesional role/title:
How did you come across my work?
Referral
Website
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Other
Other
2. The Stuck Point - What feels stuck, unclear, or not moving the way it should in your professional or personal performance right now?
3. Effort vs. Outcome - What have you already tried to address this—and why do you think it hasn’t worked?
4. Recognition and Fit - What specifically resonated with you about my work or approach?
5. Readiness - If we both felt it was a good fit, are you in a position to commit time, attention, and energy to a coaching process?
Yes
No
Unsure
6. Investment Viability - Professional coaching is a meaningful investment. If we determined there was a strong fit, would you be in a position to invest at a level consistent with executive or high-performance coaching?
Yes
No
Possibly, depending on structure
7. Boundary Check - Is there anything you believe would make this not a good fit for you? (Optional)
8. Timing and Importance - Why does it matter to you to address this now rather than later?
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