Screening Form

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Screening Form

Screening Form

Name

First Last

How did you come across my work?

Referral

Website

YouTube

Other

2. The Stuck Point

What feels stuck, unclear, or not moving the way it should in your professional or personal performance right now?

3. Effort vs. Outcome

What have you already tried to address this—and why do you think it hasn’t worked?

4. Recognition and Fit

What specifically resonated with you about my work or approach?

5. Readiness

If we both felt it was a good fit, are you in a position to commit time, attention, and energy to a coaching process?

Yes

Unsure

6. Investment Viability

Professional coaching is a meaningful investment. If we determined there was a strong fit, would you be in a position to invest at a level consistent with executive or high-performance coaching?

Yes

Possibly, depending on structure

7. Boundary Check

Is there anything you believe would make this not a good fit for you?

8. Timing and Importance

Why does it matter to you to address this now rather than later?

What Happens Next If there appears to be a strong fit, you will receive an invitation to schedule a one-hour clarity conversation. If not, you will receive a brief response letting you know that a conversation is not the right next step at this time. Thank you for your interest in Psychodynamic Success Coaching.

This field is for validation purposes and should be left unchanged.

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