testingStep 1 of 714%Personal DetailsName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Mobile*Email* Date of Birth* DD MM YYYYOccupation and Role*Organisation / Company*Are you married?*Please ChooseYesNoDo you have children?*Please ChooseYesNoBackgroundTell me about yourself? (Values, interests, hobbies, attitudes, life perspectives)*As detailed as you wish.What has brought you to here and now? (Your life journey so far)*As detailed as you wish.VisionZoom forwards 12 months. If this coaching experience was a success, what will be happening?*Be specific please.And when this is happening, what will you be Thinking and Feeling?*Be specific please.And when this is happening, how will you be Acting and Behaving?*Be specific please.And when that happens what Impact will it have on your business/profession/role and/or life?*Be specific please.MasteryWhat are you mastering? - OR - What would you like to master?*Why is that important to you?*Personal ObstaclesConsider what is preventing you now from getting what you want. What is missing or broken?*What is stuck or blocked?*What needs to change and/or develop?*What stories do you tell yourself about yourself that hold you back?*ActionsWhat stories would you like to tell yourself about yourself that would propel you forward?*What are you currently doing towards achieving what you want?*What are you not doing?*What do you need from me, your coach?*What do you need from others?*What do you need from yourself?*Ecology and Understanding Your Personal NeedsIs there anything you’d like to share that will help you and Heath build rapport, connect and communicate? How would you like Heath to communicate with you?*For Example: "Be direct Heath. Tell it how it you see it, you can cut to the chase with me." Or "Be subtle and gentle Heath. I’m new to self-enquiry and having my identity challenged."Please indicate below the styles of coaching you believe you’d prefer?* Fun and spontaneous Serious Action packed and fast paced Gentle and slow paced Information based Activity based Task oriented Meditative and hypnotic Strong accountability I'm open to whatever style Heath feels is appropriateWhich ONE of the following BEST describes your personal perspective of Spirituality?*Please chooseI am a spiritual personI am a religious personI am neither spiritual or religiousOtherWhat is your understanding of, and relationship to, God or the concept of God?*Please indicate which of the following you have had experience with.* Life Coaching Executive Coaching NLP (Neuro Linguistic Programming) Hypnotherapy Counselling Holistic Counselling Psychology Psychiatrist Meditation / Mindfulness Yoga Martial Arts Vibrational Medicine / Energy Healing e.g. ReikiIs there anything else Heath should know that may impact your coaching experience or assist him to further meet your needs? (Further preferences, personal history, diagnosed mental/physical health conditions, prescriptive medicines etc)*Please ChooseYesNo**If Yes, Heath will address during your first 1:1 coaching session
