Basic Discovery Form

Thank you for your interest in scheduling a discovery call with me. Please complete this form and I will contact you (via email) to schedule a discovery call.

Please fill in this form with as much detail as you feel comfortable sharing; this enables me to come into the Discovery Session knowing as much about you and your goals as possible, so our partnership can begin on the right foot.

Personal Information

Full Name*

First NameLast Name

Ageblanks

Email*

example@example.com

Acknowledgement

I agree to receive electronic communication from Heather Humble.

Phone Number

Area CodePhone Number

Call Scheduled for Date at Time .

How did you discover me? (IG, FB, Friend (name of friend))

Why are you reaching out to Coach Heather today?*

Main Goals

Provide top 3 changes you'd like to make.

What specific changes would you like to make?*

On a scale of 1-10, how important is to you to make this change? *

	1	2	3	4	5	6	7	8	9	10

1 is Not Important, 10 is Very Important

What specific changes would you like to make?

On a scale of 1-10, how important is to you to make this change?

	1	2	3	4	5	6	7	8	9	10

1 is Not Important, 10 is Very Important

What specific changes would you like to make?

On a scale of 1-10, how important is to you to make this change?

	1	2	3	4	5	6	7	8	9	10

1 is Not Important, 10 is Very Important

How would your life be different if you were to achieve these changes? *

What have been your barriers in creating these changes for yourself? *

How do you feel Coach Heather will help you achieve your goals? *

Coachability Self-Assessment

On a scale of 1-10, rate how ready you are to enter a coaching relationship right now. 1 = I am not ready 5= I think I’m ready 10 = I am 100% ready and excited! *

	1	2	3	4	5	6	7	8	9	10
I am open-minded about learning new ways of eating, moving, and living.
I can commit to changes that feel uncomfortable, unusual, or unconventional.
I will communicate and negotiate with my coach as an equal partnership, and feel confident to ask for what I need.
I have a high level of self-awareness.
I will keep my word to my coach and to myself.
I understand that coaching is an investment in myself, and I will not suffer about the financial cost.

Are you a mother?*

YesNo

How old is/are your child(ren)?