Maya Emelle
1:1 Coaching Form
Instructions: Please type the letter that best applies to you for each question.
1. Full Name
2. Your Email
3. Which range best reflects your current annual income?
(Type the letter that applies)
A) Under $50,000
B) $50,000–$75,000
C) $75,000–$100,000
D) $100,000–$150,000
E) $150,000+
4. Which statement best describes where you are right now?
(Type the letter that applies)
A) I know something needs to change, but I’m not sure what
B) I’m clear on my challenge but unsure how to move forward
C) I’ve tried things on my own and feel stuck
D) I know exactly what I need support with and want guidance now
E) I’m actively looking for a coach to help me implement change
5. If you felt confident this coaching would help you reach your next level, which best describes your ability to invest $2,500?
(Type the letter that applies)
A) I’m ready to invest now
B) I could invest within the next 30 days
C) I would need a payment plan
D) I’m interested but not financially ready yet
E) I’m just exploring options
6. Over the next 3 weeks, how much time can you realistically commit to coaching?
(Type the letter that applies)
A) 3–5 hours per week
B) 5–7 hours per week
C) 7–10 hours per week
D) Less than 3 hours per week