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ONE-ON-ONE COACHING

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Question 1 of 42

We are happy you are here to take the next step towards becoming your best! Shaun would like to set up a short call for 10-30 minutes free of charge to see if it is a good fit for you to work together. 

 

Let's get started with your first and last name:

Question 2 of 42

How did you hear about The Best Way To Break Free?

A

From a friend

B

Family member

C

Podcast

D

LinkedIn

E

YouTube

F

Instagram

G

Facebook

H

TikTok

I

Google

J

Ad pop up

K

Other

Question 3 of 42

Are you a coach or looking to get into coaching and looking to hire Shaun to help you facilitate this? If yes, please give any details about your current practice and what you hope to achieve by hiring Shaun to help you with this.

Question 4 of 42

What is the best phone number to text you at?

Question 5 of 42

What is the best email address to contact you at?

Question 6 of 42

What is your Instagram handle?

Question 7 of 42

What is your sex?

A

Female

B

Male

Question 8 of 42

What is your birthday?

Question 9 of 42

What is your relationship status?

A

Single

B

In a relationship

C

Engaged

D

Married

E

Divorced

Question 10 of 42

Do you have children? If so, how many and what are their ages?

Question 11 of 42

Please note that this application is private, only Shaun will be viewing it and your answers will not be shared with anyone else. What made you decide that you want to work one on one with Shaun?

Question 12 of 42

What is the single biggest struggle or block you have in your life right now?

Question 13 of 42

Do you need help stopping any self-sabotaging behaviours?  If so, what are they? 

Question 14 of 42

Do you struggle with escapism?

A

Yes

B

No

Question 15 of 42

Do you have a hard time sitting with your feelings?

A

Yes

B

No

C

Sometimes

Question 16 of 42

Are you looking for help to heal and let go of past pain or trauma? If so, give a summary on the pain or trauma you need to work on.

Question 17 of 42

Are you looking for help with a relationship?  If so, which relationships and what is your desired outcome with each?

Question 18 of 42

Are you looking for help to be a better and more involved parent?

A

Yes

B

No

Question 19 of 42

Are you looking for help with co-parenting?

A

Yes

B

No

Question 20 of 42

Are you wanting help with a nutritional plan?

A

Yes

B

No

Question 21 of 42

Are you wanting help with with an exercise plan?

A

Yes

B

No

Question 22 of 42

Are you wanting help with your masculinity?

A

Yes

B

No

Question 23 of 42

Are you wanting help with your femininity? 

A

Yes

B

No

Question 24 of 42

Do you lack confidence?

A

Yes

B

No

Question 25 of 42

Do you suffer with depression?

A

Yes

B

No

C

Sometimes

Question 26 of 42

Do you suffer with anxiety?

A

Yes

B

No

C

Sometimes

Question 27 of 42

Do you drink alcohol? If so, how many days a week?

A

0

B

1

C

2

D

3

E

4

F

5

G

6

H

7

Question 28 of 42

Do you smoke marijuana? If so, how many days a week?

A

0

B

1

C

2

D

3

E

4

F

5

G

6

H

7

Question 29 of 42

Do you smoke cigarettes, vape or use any other nicotine products?

A

Yes

B

No

Question 30 of 42

Are you addicted to any hard drugs?

A

Yes

B

No

Question 31 of 42

Do you use any hard drugs from time to time?

A

Yes

B

No

Question 32 of 42

Do you watch porn?

A

Yes

B

No

Question 33 of 42

Do you drink pop or any sugary drinks?

A

Yes

B

No

Question 34 of 42

Rate your eating habits on a scale of 1-5 (1 being very poor and 5 being great)

A

1

B

2

C

3

D

4

E

5

Question 35 of 42

Please describe your religious or spiritual views:

Question 36 of 42

Are you good at working with other people?

A

Yes

B

No

Question 37 of 42

How coachable are you on a scale of 1-10? (10 being the highest)

A

1

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10

Question 38 of 42

Have you worked with a coach or therapist before? If yes, please provide some details on your experience. Including what type of coach, when, and the duration of your time working together.

Question 39 of 42

Do you have any limitations or impairments Shaun should know about? This can include physical, mental or medical.

Question 40 of 42

On a scale of 1-10 (1 being not very and 10 being ready to begin coaching right now), how committed are you to changing your life?

A

1

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10

Question 41 of 42

I have the following amount of money available to invest into my growth right now:

A

Extremely limited funds

B

Limited but have access

C

Less than $500

D

$500-$1000

E

$1000-$3000

F

$3000 +

Question 42 of 42

Do you have any specific questions for Shaun?

Confirm and Submit