Welcome to Afterglow Coaching!

 Please fill out the form below to request a Complimentary Consultation with Rosalie Malter

 For each of the following life areas, how would you rate your life from 1 to 10, 10 being you couldn’t imagine it could possibly be any better?

Health

Money

Career/Business

Family

Relationships

Peace/Stress

Confidence

Learning & Growth

2.  Given these scores, what 2 areas do you want to improve over the next 6 months to make the biggest difference in your life?    (Maximum 2)

3.  If one of these areas is Health, please rate the following areas on a scale of 1 to 10:  Otherwise, skip to question 6.

            Exercise

            Diet

            Weight Management

            Unhealthy habits/addictions

            Stress management

Fun & Recreation

Nutritional products

4.     Which of these areas do you want to improve over the next 6 months to make the biggest difference in your life?

5.     If you are working with health issues, please list any physical or psychiatric diagnoses you have been given, and what medications you are currently taking.

6. If you could have more of ONE thing in your life right now, what would it be?

7.     What 3 things in your life are you tolerating or putting up with right now?

a.

b.

c.

                        Which of these are you ready to handle?

8.     Assuming all human beings have some way of holding back or sabotaging their life, which would be your favorite method?

Procrastination 

Indecisive

Arrogant/ being right

Acting as “Lone Ranger”

Tolerating

Not saying NO

Controlling life/people

Not saying YES

Distracted by secondary goals (goals that won’t make me happy)

Not always telling the truth

Other:

 

9.     If you had a coach, what would you probably get from coaching that would be most valuable to you?

Challenge

Accountability

Focus

Support

Inspiration

Direction

Sounding board

Ideas/strategies

Validation

 

10.  How coachable do you suspect you are? (open to input and feedback; comfortable in partnership; ready to make changes) 

Highly

Resonably

I’m trouble 

Please answer yes or no to the following statements: 

I understand that I may commit to a 1, 3 or 6-month coaching structure, but may still withdraw at the end of the first month if it is not what I expected. 

I am interested in:

            Hiring a coach

            Becoming a coach

            Being coached for 3 – 6 months and then becoming a coach 

If after the complimentary session we decide to work together, I would like to start:

            Within the next 10 days

            Within the next 30 days 

Do you require anyone else’s agreement before setting up a coaching structure? 

I am aware that health coaching is not the diagnosis or treatment of any disease.  For that I need to consult a licensed health professional. 

I would like to subscribe to the Malter Mix monthly newsletter.

Please give us the following Personal Information:

            Full Name 

            Home address 

            Email address

            Repeat email address 

            Home phone 

            Work phone 

            Cell phone 

            State/Province/Zip code 

            Time zone 

            Country 

            Comments