Name *

your business field *

1. business name *

2. How long have you been running your business? *

starting
1-3 years
3+ years

3. What is your biggest business challenge right now? *

4. How satisfied are you with your current business growth? *

very satisfied
somewhat satisfied
not satisfied

5. Have you tried to fix that problem yourself? for how long? *

6. What loss of revenue are you looking at every month? *

$2000
$1000-3000
$3000-$10K
More than $10K

7. Would you like a free coaching consultation? *

yes
no

8. What goal would you most like to achieve in the next 12 months? *

9. What have you already tried to solve this challenge? *

10. What do you believe is currently holding your business back? *

11. How committed are you to improving your business right now? *

Just exploring
Somewhat committed
Very committed

12. Why do you feel coaching might help you at this stage? *

13. If coaching is a good fit, are you open to investing in support to grow your business? *

yes
maybe
not sure

14. If accepted, when would you ideally like to start? *

Immediately
Within 30 days
within 45 days

15. Is there anything else you’d like me to know about your business or goals? *

Leave this field empty

Name *

Email address *

Message *

Leave this field empty

“Thank you for applying. If it looks like a good fit, I’ll contact you to schedule a discovery call.”

Contact

Emrick Garam,

Productivity & Performance

Business Coaching
L.A. CA US

Tel 323-537-6757 or 626-344-7465 - 626-DIG-PINK