Larina Kase, Performance and Success Coaching Contact
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Free Coaching Session

If you're considering pursuing coaching and would like to learn more about how it works and whether we're a good match for you and your goals, please complete the following form. If your goals are in line with the type of work we do, we'll offer you a free 20 minute initial consultation and let you know how to schedule it online.
 

Write as much as you like. This information will help us to see whether our coaching will help you in reaching your goals and will frame your session and maximize the benefits.

For more information on the work that we do or to sign up for one of our free e-zines on marketing or stress management.

Full Name

Occupation/Professional Title

Name of Company

Website of Company

 

Telephone Information:      Home

Mobile

Work

Preferred to be contacted on which telephone

Email Address

How did you hear about us? Is there someone we should thank for the referral?


What would you like to focus on in your consultation?


How committed are you to beginning the coaching process?
Very
Somewhat
Unsure
Not at all

If you are unsure, do you have any questions about coaching or the type of work we do that we can address in the first session?

Are you the primary decision maker regarding your enrollment in coaching? We request that the primary decision maker be involved with the free first session.

If no, who is?

 Yes
No

 


Supervisor/Boss
HR Director
Spouse/Partner
Other

What major changes would you like to see in your career, business, and life within the next few months? Think about what will look different in your life, how you will feel differently, what you will have learned, how key relationships would be different, and what you will have achieved.
 

  Thank you and we look forward to helping you!
 

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"Your branding strategies are great and you are an inspiration!
Thank you, Larina!"

-Melbra Watts, MBA, Infinity Calling

NOTE: We will NOT rent, trade, or release your information to any third party for any reason.