mPEAK Coaching Intake Assessment

These questions are designed to make you stop and reflect so please take your time. If there is a question that you're having trouble answering, skip it and come back to it before you press submit. If you feel there are repetitive questions you can either go deeper or just refer to a previous answer. I appreciate your willingness to share and look forward to getting to know you.

Name *
Name
Address
Address
Phone
Phone

Paperwork

Please review the following documents. If you are engaging in virtual coaching, your verbal agreement is sufficient. 

Policies & Procedures

Client Agreement

Payment

All new clients must start with the Intake Session along with an eight session package. Additional coaching sessions can be purchased at any time. Below is a link to the online credit card option. However, if it's all the same to you, my preference would be a check which can be made out to me, Pete Kirchmer and sent to: 227 Neptune Ave., Encinitas, CA. 92024. 

Intake Session
300.00
Quantity:
Add To Cart
8 Coaching Sessions
1,200.00
Quantity:
Add To Cart