Discovery Info
Add New Client
Date
Full Name*
Mobile*
Email*
Country*
Canada
USA
Province/State*
Random word
Spouse / Partner Name
Spouse / Partner Mobile
Spouse / Partner Email
Relationship Status*
Single
Married
Divorced / Separated
Single Parent
Divorced / Separated with children
Adult Children at home
Yes
No
Children Ages, separated by comma
Which one describes your situation on a scale of 1 to 3 indicating the level of urgency and you're looking to improve your financial situation and get out of debt?
'Not urgent: You may have some debt, but youre managing it well, and it's not causing significant financial stress.'
Moderately urgent: Your debt is causing noticeable financial stress, and you're actively seeking ways to improve your money management and reduce debt.
Highly urgent: Your debt is causing severe financial distress, and you're feeling desperate to find solutions to change your money relationship and eliminate debt as soon as possible.
What is your annual household revenue?
Less than $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1 million
Over $2 million
How much debt do you have?
No consumer debt or minimal debt (up to $10,000)
$10,000 - $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
Overwhelming consumer debt (over $500,000)
What is your credit score?
Bad (below 600)
Poor (600-649)
Fair (650-699)
Good (700-749)
Excellent (750+)
Goals 3 / 3*
Goal 1 / 12*
Greatest Challenge*
Coaching expectations*
On a scale of 1-10 (10 as high) rate the following
Your health*
Your life*
Your amount of stress*
Do you own a company?*
Yes
No
Any additional questions or comments
How did you hear about us
Social Media
Friend/Colleague
Advertising
Event
Send my info and go to calendar
Discovery Info