Complimentary Consultation First Name:* Last Name:* Address: City: State: Zip: Email:* Phone:* Alternate Phone: How did you hear about me?* Radio ShowReferralSpeaking EngagementInternet SearchWebsiteFacebookTwitterPinterestBook What do you hope to Achieve by working with Me?* ---Change My Relationship with Maney, Wealth & AbundanceShow Me How to Succeed: Business Development/CoachingHeal My Past (Release Trauma)I Need Help! Crisis Management (Includes Phobia Release)I Know There's More: I'm Ready to Explore My Spiritual NatureImprove My Health (Weight Loss, Quit Smoking, Pain Management, Though Management for Chronic Illness)Heal from Loss of a Loved One (Death, Divorce, Break Up)Change My Love RelationshipsI Want to Discuss Training Options How Does this problem Hold you back in Life? What Have You Tried So Far That Hasn't Worked?* How Important is it to Overcome this issue now?* ---My Top Priority Right NowImportant, but Not Top PriorityAverage, I know I Need to take Care of this at Some Point If You Could Create Your Ideal Solution, What Would it Be?* After 12 months, if you resolve this issue, what is your life like now?* What Do You Think Holds You Back From Achieving Your Dreams/Goals/Ideal Life?* Tell Me About Your Faith/Spiritual/Religious Beliefs.* Have You Invested In Coaching Before?* How Much Money Have You Invested in Yourself in the Past 12 Months?* ---Under $2,500$2,500-$5,000$5,000-$7,500$7,500-$10,000Over $10,000 Clothing, Spa, Workshops, Vacations, etc... Please Tell Me What You Expect to Get from My Programs* How Committed Are You to Changing in Order to Achieve Your Goal to Live a Happier, More Fulfilled Life? ---100%, WHATEVER IT Takes I'll Do It!It Depends on What's InvolvedI Have a Challenge with Either Committing to or Following Through Describe How You Stop Yourself When Trying Something New or Facing a Challenge.* Tell Me anything Else You Want Me to Know Before we Speak.* By submitting this application I acknowledge that I am interested in coaching and or training services and will receive a complimentary 20-30 minute phone consultation with Lance Jaynes. I understand that space is limited and acceptance in this program is based on availability. I understand that participating in one of Lance's programs requires a financial investment and I am ready and able to make that commitment to myself for personal development.