One to One Coaching Form

Your first name *

Your last name *

What is your best email? *

Your phone number *

What best describes your current situation? *

I am a Business Leader (with direct reports) looking for more.

I am a Business Owner looking for a new kind of success.

I want a meaningful AND successful business of my own.

I am a SOLO Entrepreneur and wanting more

I want to advance in my current career.

I am a colleague of Nina's

Other

How did you originally hear about me? *

Worked with a Coach Before *

Yes

No

If you have working with a coach, what were the results?

If I could wave a magic wand and make 3 of your biggest business challenges disappear, what would they be? *

What keeps you up at night? *

What is getting in the way of moving forward or reaching your goals? *

What is your current household income? *

What is your DESIRED household income? *

If I could promise to close the gap between where you are now and where you want to be, how much are you willing to invest in yourself monthly for coaching? *

$5000+ a month

$2500 - $5000 a month

$1000 - $2500 a month

less than $1000 a month

What times are you available for coaching? Please select based on Eastern time. (If you are in Sydney Australia it would be a 16 hour difference.)

Weekday Mornings (8:30am - 11:00am Eastern)

Weekday Afternoons (Noon - 5:00pm Eastern)

Weekday Evenings (after 5:00pm Eastern)

Anything else you think I should know? *

Enter the above code:

Pin It on Pinterest