Greetings!

Please take a quick moment to complete this brief application for Bernice's coaching programs. As soon as it is received, someone will contact you and let you know how to proceed to the next step.


First Name:

Last Name:

Best Email Address:

Phone:

City:

State:

Best Time to Contact (include time zone):

Website:

How did you hear about my services?

Please describe your business and what product and/or service you provide.

What do you most need to happen in your business right now?

What are your 3 biggest challenges that are holding you back from reaching your goals in your business right now?

What is your long term vision for your business... and you?

What are you looking for in a coach?

What obstacles and struggles come up for you on a regular basis?

What would you like to see happen as a result of working together?

When it comes to growing your business, what do you consider your biggest strength?

When it comes to growing your business, what do you consider your biggest weakness?

What difference would it make for you once we achieve your goals together?

Is there anything else or any other concerns that you would like for me to know?



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