Receive FREE 45-minute life coaching session -- Visionary Life Coaching, thought provoking questions to change your life.


How to Get Started

To get started answer the questions below. Once received I will contact you via email within 24-48 hours to arrange your complimentary coaching session!


Daytime Phone Number:
Evening Phone Number:

Address (including city, state & zip):

Email Address:


How many hours per week do you currently spend at work?
20 or less 20-30 30-40 40-50 50-60 60+

Briefly describe your typical day.

What three things do you like about your life?

What three things do you dislike about your life?

What would you say are your three greatest accomplishments to date?

What major transitions have you made in the past 5 years (i.e., moved to
a new town, marriage, divorce, new job, etc.)?

What is the most difficult obstacle you have overcome?

On a scale of 1-10 how much stress do you have in your life? What is the
main area causing you stress (i.e., health related, financial, relationship, etc.)?

If resources (money, time, location, etc.) weren't an issue, what would you be, do, or have?

What are your primary goals in seeking assistance at this time? What, more
than anything, do you hope to gain from working with the life coach?

How did you hear about Susan Shapiro and Visionary Life Coaching?

Additional comments:

Best days and times for your complimentary consultation:



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