This form is for our new clients, but guests are welcome to fill it out and submit it as well if they wish. This form helps us get to know our new clients before we have a consultation call and allows us to determine if a person is a good fit for our services or not. We can use our guests' submissions to help us improve our services and processes - that is why we welcome both types of submissions on this particular form.

At Valor Pathways, we believe every transformation begins with a conversation. That’s why we offer *one free, no-obligation consultation call to every new client. This is your chance to connect with a Valor Pathways Chain Breaker Coach, share your goals, and see if our coaching approach is the right fit for you. Ready to take the first step? Just fill out the form below, and we’ll be in touch to schedule your complimentary consultation.

*Our Free Consultation Calls range from 15-30 minutes, depending on the services being discussed.

*We reserve the right to refuse any request for calls and coaching services at our discretion.

Basic Information

First Name *

Last Name *

Phone *

Email *

Tell us where you are from in this beautiful world. This is only to help us get to know our website visitors better.

City *

State *

Country *

*NOTE: At this time, we only provide our coaching services to clients in the USA. We apologize about any inconvenience this may cause. If you are in another country and are interested in personal life coaching, please let us know as we are gauging interests in expanding our services outside the USA.

About You Assessment

Who Are You? What Are The Qualities & Characteristics That Define You? Write Down At Least 5 Characteristics. *

What's Going Well For You? *

Do You Feel That You Have A Support System Around You (Family, Good Friends, Supportive Community, Etc.)?

Yes

Do You Live With Your Spouse, Family, Friends, Alone, Or Other? *

I Live With My Spouse And/Or Family

I Live With Roommates And/Or Friends

I Live Alone

I Am A Single Parent Living With My Children Full Time

I Am A Single Parent Living With My Children Part Time

Other

If Other, Please Explain: *

Do You Consider Yourself A Spiritual Person And/Or A Person Of Faith?

Yes

Needs & Goals Assessment

Why Do You Want To Hire A Chain Breaker Coach? *

What Are Your Big Picture Goals? *

What Are Your Biggest Challenges? *

Basic Health & Wellness Assessment

Do You Have Any Medical Conditions That Need To Be Taken Into Account As Part Of Your Coaching Program? *

Yes

If Yes, Please Explain: *

How Many Hours Of Sleep Do You Usually Get Per Night? *

More than 9 Hours

7 - 8 Hours

5-6 Hours

4 Hours Or Less

Tell Us About Your Activity Level *

I workout at least once per day.

I workout a few times a week.

I workout once per week.

I don't workout and am mostly sedentary.

Emotional Intelligence Assessment

Do You Feel That You Have A Mostly Pleasant Life That You Feel Engaged In, As Well As Finding It To Be Interesting, Full Of Wonder, & Excitement? *

Yes

Sometimes

Do You Consider Yourself An Emotional Person And/Or An Empath? *

Yes

Do You Consider Yourself An Optimist?

Yes

Do You Consider Yourself A Patient Or Impatient Person? *

Patient

Impatient

Somewhere In Between The Two

When You Are Angry, Upset, Or Disappointed, How Do You Respond To Others & How Do You Deal With Those Emotions Internally To Feel Better? *

Creative Assessment

Answer This Statement With True Or False: "I Make The Time To Explore My Creative Side & Enjoy Activities That Let Me Be Creative." *

True

False

Answer This Statement With True Or False: "I Have A Hobby Or Multiple Hobbies That I Enjoy Doing & That I Make Time To Do On A Regular Basis." *

True

False

Name An Activity That You Enjoy Doing, That Gives You A Sense Of Purpose Or That Triggers Positive Feelings: *

Learning Methodology Assessment

Do You Like Learning New Things? *

Yes

Write Down A List Of Areas That Interest You That You Would Like To Learn More About. *

How Do You Learn The Best? *

Independent Study (Reading, Watching Videos, Researching, Listening To Podcast, Etc.)

One On One With The Coach/Teacher (Having Someone To Verbally Speak With & Listen To, Etc.)

Team Setting (Round Table, Live Sessions, Discussions With Like-Minded People, Etc.)

Combination Of All The Above Options

Commitment To Change Assessment

Are You At A Point Where You Are Fed Up/Disgusted With Your Current Situation? *

Yes

Are You Ready To Take The Steps Necessary To Make Real Change In Your Life? *

Yes

Captcha

I agree to terms & conditions provided by the Valor Pathways. By providing my email address, I agree to receive email messages from Valor Pathways and their partners/affiliates. By providing my phone number, I agree to receive phone calls and text messages from Valor Pathways (and understand that text messages my incur additional fees through your phone service provider depending on your plan).