If you’re not quite ready and want more information about coaching – click here. 1-1 Coaching Inquiry Questionnaire Are you interested in One-to-One Private Coaching? Great! Fill out the questionnaire! Email* Name* First Last Address* City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe What is your current situation/business/problem that causes you to seek coaching?*When you think about your business and these issues - what would you like to have/where would you like to be in one year? Be as specific as you can be - but don't worry if you aren't sure - just do the best you can here.*What are the 3 biggest obstacles preventing you from being there now?*(Choose 3 from the list below. If you choose "other", please explain in the field below.) Time Management Issues Lack of Skills/Knowledge/Education to accomplish my goals Fear Lack of confidence or belief in myself Lack of a Team to support me in building my business Financial issues (either lack of funds or money management skills) Issues in the business environment Other (fill out details below) OtherIf we discover we're a good fit, How ready are you to invest the time/energy into working together? On a scale of 1-5, rank yourself on your readiness to invest the time and energy. (You can expect to spend several hours/week, every week, in between sessions working towards your goals.)*(Highlight one choice)5 - I'm ready to start immediately4 - I'm mostly ready3 - I'm somewhat ready, and I have some concerns2 - I have an expectation of being ready in the future1 - Not at all ready at allWhat monthly investment in your career/business would you be willing and able to make?*(Choose one investment level)Under $100$100-$200$200 and aboveDebra Russell's Words to the Wise Newsletter*This occasional newsletter is filled with tips to help you be more successful in your business. We respect your privacy and will never share or sell your email. Please add me. I understand I can unsubscribe at any time Do not add me to your email list EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.