Coach Linda Richmand

Offices in White Plains & Mt. Kisco

914-330-9103 LSRichmand@aol.com

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

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 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 _______________________.

More Specific Goal Information:

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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