Thank you for your interest in working with me. 

My private coaching is by referral or invitation only. I only work with a handful of private clients at a time.

To see if or how I can help you and if we are a fit to work together, please take the time to fill out this form as honestly and as detailed as possible. All of your information is kept confidential.

You will receive an email reply within three business days to outline the next steps in moving forward. 

Love and respect,
Jeffrey

visit | www.jeffreyplatts.com
Begin
 
Full Name *

 
Email *

 
Where do you live? *

 
Phone Number and/or Skype *

 
What SPECIFIC circumstances have you reaching out work with me right now? *

 
Over the next 12 months, in what specific areas of your life are you wanting to see serious results? *


 
What’s your current lifestyle like? *

 
What are your three biggest strengths? *

 
What are your three biggest weaknesses? *

 
Your financial resources *


 
If you were to look back, 3 years from now, and say “Investing in coaching was one of the best decisions in my life.” What has to have happened — both personally and professionally — for you to feel thrilled with your progress? *

 
If you wind up being disappointed with your results, why will that be? How are you currently getting in your own way? (e.g., unhealthy relationships, recurring problems, limiting beliefs, poor habits, disorganization, etc.) *

The point of this question is that we KNOW, in advance, exactly why we are going to fail at some endeavor...so it’s useful to write that reason down BEFORE the endeavor so we can eliminate that reason for you now and allow you the freedom to achieve what you choose to achieve.)
 
Explain where all your time is currently spent. Where should it be spent? *

 
What do you currently do to earn income? (If more than one, mention all.) *

 
What was your income or revenue the past 12 months? *


 
What other mentors or coaches have you worked with? What had you stop working with them? What other personal growth programs have you done? And, more importantly, what lessons have you learned? *

 
How much have you invested in your own personal growth in the past 12 months? *


 
If you are a right fit for me to take you on as a client, how able and willing are you to invest (time, energy, finances) in your personal development right now? Why now? *

 
What excites you about hiring a coach? *

 
Why specifically do you want to work with me? *

 
Complete this sentence: "When it comes to my life, I am..." *


 
How did you hear about me? *

 
Anything else you want me to know?

 
Thank you for your application. I honor your courage in taking the first step to creating the life you truly want. And I am looking forward to seeing if or how I can support you in creating the powerful results you want. You will receive an email reply within 2 business days to outline the next steps in moving forward.

Love and respect,
Jeffrey

Thanks for completing this typeform
Now create your own — it's free, easy & beautiful
Create a <strong>typeform</strong>
Powered by Typeform