*1.Contact Info(Zorunlu.)

Name-Surname *

Your Occupation

Country /State /City

Your website (if any)

Skype *

E-mail *

Phone *

*2.What is your age?(Zorunlu.)

20-25

25-30

35-40

40-45

45-50

50-55

Please specify your age...

*3.Why would you like to talk to me? What would you like to find out?
What’s your biggest / most frustrating challenge right now?(Zorunlu.)

*4.What  is your biggest desire in your life?; If you have a magic wand in your hand what would you like to be / do / have?(Zorunlu.)

*5.What is your 3 biggest challenges or blockages to have this /these desire at the moment?(Zorunlu.)

First biggest challenge;

Second challenge;

Third challenge;

*6.If you do not find a solution to this frustration / problem within 6 months, what will happen and how do you feel?(Zorunlu.)

*7.Are you in any other coaching programmes or therapy, medication right now? If so, which one(s)?(Zorunlu.)

Yes

No

If "yes" please specify....

*8.How committed are you mentally, emotionally, financially to make this change in your life and get the result you would like? (Please count 0-10, 0 is not committed, 5 moderate, 10 fully committed)(Zorunlu.)

*9.Please write time and date in your Time-zone so I can make arrangements accordingly;(Zorunlu.)

First option;

Second option;

Third option;

Your Time Zone:

*10.Are you currently subscribed to Nilgun's email list? If not, would you like to be added?(Zorunlu.)

Yes, I am already subscribed.

Yes, I would like to subscribe.

No thank you.