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
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Full Name *

 
Email *

 
Where do you live? *

 
Phone Number or FaceTime/Skype ID *

 
In what life areas are you wanting to see serious results and improvement? *


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

 
What actions and methods have you already done to try to improve these areas of your life? *

 
What do you currently do for work or business? *

 
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? *

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


 
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

* Be sure to continue and click "Submit Application" below!

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