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Tell Me About You

After you submit this form hit the back button to add your Private Coaching Package to the cart to complete your registration. You and I will both receive a copy of this form for our records.

I look forward to being a member of your success team!

This is your chance to tell me about you and your business. When you complete the questions below both you and I will receive a copy of this form via email. At the bottom of the form is the coaching agreement. Please check that you agree to the terms before proceeding to check-out.

What is your company name?

What is the address and phone number you would like to use for your coaching sessions?

What is the month and day of your birthday?

Do you have a website? What is your website address?

How long have you been in business?

If our time together exceeded your expectations, what would you have that you don’t have now?

Where would you like to see yourself and your business in the next 6-12 months?

What are you most passionate about or inspired by?

What are the greatest challenges or barriers you are faced with in growing your business?

What have been your greatest achievements in your business to date?

List 3-5 things you are tolerating or putting up with in your business?

I understand and agree that my private coaching package is a month-to-month agreement and that my credit card will be billed every 30-days for as long as I am a member of the program.

Yes

No

I understand and agree that my coach will call me at the scheduled time for our private coaching session and that if I wish to cancel or re-schedule a session I must contact SpringAhead via email 24-hours prior to my scheduled call.

Yes

No

I understand and agree that if I do not show up for my scheduled coaching call, and I have not re-scheduled my call in advance, I will forfeit that session for the month.

Yes

No

I understand and agree to be honest and communicate with my coach anything that upsets me or does not feel right so together we can resolve the issue.

Yes

No

I understand and agree that my coaching agreement with SpringAhead is a month-to-month agreement and I can cancel anytime. To cancel my agreement, and prevent my credit card from being charged, I need to contact SpringAhead 5 days prior to my next scheduled billing. No refunds will be issued for partial months used.

Yes

No

I understand that SpringAhead respects my confidentiality. Anything shared during a coaching session will not be shared directly or indirectly with others without your prior permission.

Yes

No

I understand and agree that the exception to the confidentiality agreement is for certification purposes to maintain professional coaching designations. I permit SpringAhead to provide my name, duration of coaching relationship, name, phone number, and email address with professional credentialing bodies.

Yes

No

I understand and agree that the coaching relationship is in no way meant to be construed as psychological counseling or therapy.

Yes

No

I have read and agree to all the terms above. I understand that my adding my name and today’s date I am providing my electronic signature.

Your Name:

Your Email:

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