Name * First Name Last Name Email * Phone * (###) ### #### Preferred Method of Contact * Email Phone Text Where are you in your life right now? * Briefly describe your current personal or professional situation. What made you reach out for coaching at this time? * What areas of your life are you most interested in exploring or improving? * (Select all that apply) Career/Leadership Relationships Health & Wellness Confidence & Self-Worth Parenting or Family Life Navigating Life Transitions Clarity and Direction Sports or Performance Mindset Other Are you ready to make meaningful changes in your life? * Strongly Disagree Disagree Neutral Agree Strongly Agree What would success look like for you in 6 months of coaching? * Have you worked with a coach, therapist, or mentor before? * Yes No I offer weekly 50-minute coaching sessions over the phone. Sessions are $175 each (see pricing plans for additional information) * Are you ready to invest in yourself at this level? Yes, I’m ready I’d like to learn more before committing I’m unsure and would like a clarity call How did you hear about BET Coaching? * Word of mouth Social Media My website Referral Other Anything else you’d like me to know before we connect? Consent * I understand that this intake form does not guarantee a coaching relationship and that coaching is not a substitute for therapy or medical treatment. Thank you! I’ll be in touch within 24–48 hours to schedule your initial consultation. Breakthrough • Elevate • Transform You can BET on it. BET Coaching & Consulting
