Shine Bright 1 on 1 Coaching Application

Welcome to Shine Bright Mindset Coaching!

Please fill out this questionnaire so we can get to know you, your goals, and how to best support you in your process.

Full Name *

Email *

Phone *

Would you like to receive text messages? (Select one option) *

Yes

No

Please Rate all 7 areas of life on a scale of 1-10. 10 means that you are living your dream life in this area, and 1 means that it could be much better. Indicate a rating that relates to you and your situation right now, and then describe why.

Finances *

Family *

Friendships *

Health *

Hobbies *

Business/Career *

Giving Back *

Please choose 3 areas of life that you would like to see the most change in: *

Why would changing these 3 areas impact your overall quality of life? *

If you had to pick 1 area of life to focus on 1st, which 1 would impact other areas the most? *

I know that we can love all areas of our life but we often can't work on them all at the same time. One problem people make is trying to change everything all at once. I recommend choosing one 3 month goal at a time.

Over the next 3 months, I am focusing on: *

Over the next 3 months, I would like to see these specific shifts & changes in this area of life: *

My 90 Day Goal is: *

What are some new actions I need to take in order to see this change? *

What are some reason why I haven't made these changes in the past? *

Has anything else gotten in my way in the past? *

How can I overcome this obstacle this time? *

Does something need to be removed from my calendar in order to make room for this new priority? *

Is there anything else that might stop me from making this change? *

How committed am I to making this change? (Scale of 1-10, 1 being "not committed" & 10 being "very committed") *

What is my plan if something gets in the way of my new priority? *

Who is going to hold me accountable? *

How am I going to celebrate after I complete the successful 90 Days? *

Imagine your life in 90 days with a completed goal or some new habits what are significantly adding value to your life. Spend some time thinking & writing about how it will feel to be experiencing success in this area of life.

Describe how you feel & what you are experiencing. *

Thank you for completing the application!

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Shine Bright Mindset Coaching, LLC

690 Main Street #1038

Safety Harbor, FL 34695-3551

United States