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Private Coaching Session Application

This form helps me understand your goals and how we can best support you.
Your answers will guide us and remain fully confidential.
Take a moment to answer honestly - this is your space to begin.

Dr. Homeyra Faghihi
Empowerment Coach - Founder
Power to the Self

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Question 1 of 10

What is your first and last name?

Question 2 of 10

What is your email address?

Question 3 of 10

Instagram name/handle?

Question 4 of 10

Envision yourself at the end of our work together. What do you see? What transformation you accomplished?

Question 5 of 10

How would you describe your current view of you? Please list your limiting beliefs. 9expample: I can never get it right. I can never find the right partner.)

Question 6 of 10

On a scale of 1 to 10 - 1 represents: "I am worthless" - 10 represents: "of course, I am worthy." - Where are you on the scale?

Question 7 of 10

What problem would you like to solve by completing Power To The Self coaching program?

Question 8 of 10

What have you tried so far to solve the before-mentioned problem? To what extent did it work? or not?

Question 9 of 10

Where/how did you learn about Power To The Self?

Question 10 of 10

Dr. Faghihi's private coaching sessions are limited in availability and highly customized for your needs. We kindly ask that you prepare your finances in advance. This might involve discussing this with other decision-makers at home, or rearranging funds. Are you ready to Invest in Your Growth? Private coaching sessions are in the $1500 and $3000 range. A partial REFUND offer is available. Please choose one of the follwoing responses:

A

Absolutely Ready: I'm 100% committed to moving forward if we're a good fit.

B

Conditionally Ready: I'm ready if we are a good fit, but I need to discuss it with another decision-maker first.

C

Not Ready yet: I'd love to recieve coaching, but I'm not ready to invest at this time.

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