Request to explore working with Kim Beckers

Full Name *

First Name Last Name

E-mail *

Phone Number *

Area Code Phone Number

Website URL *

How long have you been in business? *

What is your business/Describe your business? *

What products and/or services do you offer? What price do you charge for each product/service? *

Who are the clients you work with? *

What is your "why" What drives you? *

How much profit do you make each month? *

How much profit do you want to make each month? *

What results do you help your clients achieve? Anything you would like to share that you are most proud of helping them achieve? *

Why do you believe you are not reaching your targets/goals/intentions right now? *

How did you hear about Kim? *

What has motivated you to reach out to Kim today? *

Have you purchased any of Kim's trainings? If so, please list them here *

What is your main goal? In 12 months time, if you were to look back over the last year where would you be in terms of business, finances and happiness? And what do you believe would have happened for you to achieve that? *

What are the biggest three challenges you are facing in building your business? *

Why do you want Kim's help in getting there? *

Are you motivated to make the necessary changes to reach the results you want to achieve? *

Yes No

Do/are you willing to take full responsibility for your life and results you create? *

Yes No

Do you consider yourself "coachable"? *

Yes No

What is your time frame for implementing these changes? ie. what is your sense of urgency for following through and doing the work? *

If we determine it’s a good fit to work together are you ready to move forward and invest in mentoring with Kim (financially and time wise)? If not, what would stop you? *

Why do you believe you are a good fit to work with Kim? *

Any other information? *

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