MindStory Academy

Application for a FREE Breakthrough Coaching Session

with Carla Rieger

Please complete the survey below so that we have the necessary information to maximize the time we have to spend together on your call. If we think there might be a good fit, we'll contact you to set up the call.

First Name*
First
Last Name*
Last
Email*
Best "Contact" Phone Number
Current Website URL (if applicable)
Other URL (if applicable)
Main Social Media URL (if applicable)
Call Preference*
- Phone
- Skype or Zoom with Video
- Skype or Zoom Audio Only
When participating in coaching/training do you prefer*
- 1-to-1
- Group
- A Combination of Both
- Not Sure
What type of business are you in (i.e. health coaching, facebook consulting, financial services)?*
Part II: THE PAST
What are your three biggest accomplishments to date? And why are you proud of them?*
Tell us about your business/career success over the past 10 years. (The impact you've had, the income you've created, and your clients' success stories)*
What has been your average business revenue/work income per year?*
[Entrepreneurs] What has your largest monthly income been in the past 24 months?
[Entrepreneurs] On average, how much revenue are you currently generating each month?
What was your TOTAL combined HOUSEHOLD income over the last 12 months (this includes you, your spouse/partner, your business income AND income from a job if you are in transition)?*
How did you hear about Carla Rieger or about this coaching opportunity?*
What would you like to accomplish that looks impossible but if it were achieved would change everything?*
What do you think you could use the most help on?*
What resources do you have in place now to help you succeed? People, skills, resources, connections, clear offering, etc.*
If we could provide you a solution to overcome your challenges so that you could consistently hit your monthly income goal and grow your business, what type of resources do you currently have to invest in a solution? This should include your current available capital, savings, credit, loan or other available resources. (Note: this will determine how we approach what solution we recommend.)*
- I don't have the resources right now
- Less than 2K
- 2K to 5K
- 5K to 10K
- 10K to 25K
- 25K plus
When are you ready to start working with a coach?*
- Right Away
- Next Week
- Within Two Weeks
- Sometime in the future beyond 2 weeks
- Not Sure
How committed are you achieving your goal?*
- I'm going to do whatever it takes to get to the next level
- It would be nice but I have a few other things that are my priority right now
- I’m really just exploring to see if I even want to commit myself
- Not Sure

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