Coach Richmand LLC

New York Locations:  Harrison: 500 Mamaroneck Ave. Mt. Kisco: 100 South Bedford Rd.

Telephone & Skype Coaching From Anywhere   914-330-9103     lsrichmand@aol.com

1) Please select the area(s) in which you would like to move forward?   Career Advancement Entrepreneurship/Small Business Life Balance Adult ADD/ADHD Coaching Parent Coaching Parent Coaching for parents with child diagnosed with ADD/ADHD

2) In addition to goal achievement, coaches work with clients toward mastering life skills. Which life skill(s) listed below do you feel you could benefit from focusing upon?

Goal Setting Staying on Task/ Focus Organization/Prioritizing Living Your Values Learning Coaching Skills to Use at Home or Work Brainstorming Ideas & Solutions Chunking Down Large Goals Into Smaller Doable Tasks Overcoming Obstacles Other (Use space at end to elaborate)

3) In the box below please complete the following sentence: I am interested in coaching because I hope to _______________________.

I hope to.....

4) On a scale of 1 to 10 (10 being the greatest) how badly do you want to achieve your professional, personal or parenting goals?

1 - 2 3 - 4 5 - 6 7 - 8 9 - 10   6) So that I may respond, please provide the following information: Name:  * required Telephone Number: Email Address:

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