First Name *

Last Name *

Phone *

Email *

City *

State *

Are you a parent? *

Yes

If so how many and what ages?

What are you currently struggling with or wanting coaching around? *

(Health, fitness, relationships, mindset, discipline, confidence, life direction, etc.)

How long have you been dealing with this? *

What have you already tried that hasn’t worked? *

What would a “win” look like for you after this conversation? *

Why do you feel ready to talk about this publicly and receive coaching on air? *

Have you listened to the Brad Jensen Show before? *

Yes

Are you comfortable being recorded and having this episode published publicly? *

Yes

Time Confirmation *

I confirm that I am available Mondays at either 9:30 AM or 10:30 AM Mountain Standard Time