If you’re not quite ready and want more information about coaching – click here. Private Coaching Inquiry Questionnaire Are you interested in One-to-One Private Coaching? Great! Fill out the questionnaire! Email*If you use more than one email and you are receiving emails from me - please use the SAME email (to avoid duplication). Name* First Last Phone Number*Please give me your best phone number. If you are not in the US - please include your country code.Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe What is your current situation/business/problem that motivated you to seek coaching?*When you think about your business and these issues - what would you like to have or 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 (Don't know if I'm good enough) 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) OtherGoing after your goals takes a significant time commitment. On a scale of 1-5, rank yourself on your readiness to invest the time and energy to make your goals happen.*(Highlight one choice)5 - I'm all in - this is my fulltime gig!4 - I'm working a fulltime job, and I'm ready to invest 5-10 hours/week3 - I can make the time, but I'm not that effective with time management2 - I'm struggling to get done what I already have on my plate1 - I'm completely overwhelmedWhat monthly investment in your career/business would you be willing and able to make?*(Choose one investment level)Under $100/monthUnder $200/monthUnder $500/month$500 or more/monthDebra 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 CommentsThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.