Private Coaching Application

Thank you for applying for my private coaching services. I am eager to learn more about you and your relationship with money!

Once your application form has been received I will contact you to schedule a brief phone call so we can discuss your needs and goals and how I can support you in achieving them.

I acknowledge you for taking action to learn more about how Financially Smitten can serve you to move beyond whatever is getting in the way of your being able to rock YOUR money mojo! I look forward to hearing about your money story. Remember, I am here to hold your hand and guide you. Money no longer has to scare or mystify you.

Please take some time to thoughtfully respond to the questions below. Note that all fields below marked with an asterisk* are required. Also know that all responses are kept COMPLETELY CONFIDENTIAL.

Full Name*

Primary Email*

Phone Number*

Time Zone*

Address 1

Address 2

City

State

Zip Code

Country

What financial concerns have brought you to the Financially Smitten website?*

How long have you been dealing with these concerns?*

How would you describe your current relationship with money?*

Have you sought help for this prior to visiting the Financially Smitten website? Why or why not?*

If yes, what strategies did you try? Did they work? Why or why not?*

What would your dream relationship with money look and feel like to you?*

On a scale of 1 to 10 with 10 being the most serious, how serious are you about taking the necessary steps to create your dream relationship with money?*

Do you have any financial goals you are currently working towards? If so, what are they and what steps are you taking to achieve them?*

What is attracting you to have a Financially Smitten*

What makes you an ideal client for Financially Smitten coaching?*

So that I may serve you in the highest way, what else is important for me to know about your relationship with money?*

How did you initially find Financially Smitten?*

In what ways have you already connected with Financially Smitten? [Copy & Paste all of the choices that apply in the box below]*

Flirting with Finance Diaries Newsletter Subscriber    Connected to Financially Smitten on Facebook    Connected to Financially Smitten on Twitter    Subscribe to the Financially Smitten Blog    Heard Lora speak at a live event    Attended a Financially Smitten workshop    Know someone who has been coached by Lora    Other (Please Specify)

Other comments or notes you would like to add ...

Thank you for completing the application. You will be receiving an email from me soon to schedule a phone call. I look forward to connecting with you!