Private Coaching Form

Private Coaching Application Form
Message from Peter:

Aside from the general information, this application contains three sections. The first helps me understand your goals and reasons for wanting to apply for my exclusive one-on-one program. The second helps me understand and appreciate the bigger picture of you and how it relates to your life. The third helps me understand where you are performing or struggling. Please be honest and transparent in your replies so I can be honest in knowing how to help. Your application is CONFIDENTIAL and will be seen only by myself.
Title
Your title
Full Name*

First Name Last Name
Contact Number

Area Code Phone Number
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Preferred Email:*
[email protected]
Main Website if any:
You Website
Your Current Age:
Your Age
Main Occupation:*
Your Occupation
Marital Status

SingleRelationshipMarriedDivorcedOther
Personal Income/Yr: *
What Length Of Engagement Are You Most Interested in:*

1 Year6 MonthsUnsure
Part 1: Your Ambitions With Peter & The Private Coaching Program
What motivates me most to be personally coached and mentored by Peter is:
If I had to focus on just three goals for my life or business, they would be:
If I had to list the #1 challenge in preventing me from already achieving these, it would be:
Part 2. My Big Picture:
The areas of my life I feel I am most succeeding in right now are:
In general, I feel I need to most work on the following in my life right now:
When I feel my best, most successful and happy self, it is because:
If I could wave a magic wand and make it happen, I would make my life about this:
The 3 big changes I would most like to make about my current life in the next 12 months are:
What I am most proud and excited about in my life right now is:
Part 3. Your Performance Patterns
What negative recurring thoughts, fears, or behaviours would you like to overcome in order to feel even more psychologically free, confident and successful?
What eating, exercise or general health habits would you like to begin or break in order to feel stronger and healthier physically?
What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently?
How many hours are you really working on your business each week, and how many contractors/employees/assistants do you have, if any?
If you were even more persuasive or influential, what dream or desire would you ask others to support you in achieving?
Do you struggle to be fully present in your day or in any of your relationships? If so, is there a pattern of when this most commonly shows up?
How purposeful do you feel in living each day, and how would you describe your current purpose?
Application & Program Fees

There is no charge to apply for the Private Coaching Program. However, after completing this application, should you be invited to proceed, a fee of $500 will be required to book a 30-minute Zoom interview with Peter to assess final suitability. The application fee ensures you are serious, and that Peter’s time is spent with committed clients. If you are accepted and agree to proceed, the $500 fee is credited to the cost of the program. If you are not accepted, then the $500 will be refunded.
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Private Coaching Form

Private Coaching Application Form

Part 1: Your Ambitions With Peter & The Private Coaching Program

Part 2. My Big Picture:

Part 3. Your Performance Patterns

Application & Program Fees

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