Coaching Inquiry Form


Please answer the following questions as thoroughly as possible. We receive a large volume of inquiries. The more information you can provide, the easier it will be for us to determine if our services are a good fit for you. Please be assured that the information you submit will treated confidentially.

Kind regards,

Heather Blackmore
Optimal Coaching


NOTE: Please click on SAVE & SEND when you have completed the form.
Once you have done so, a small pop-up message will appear briefly confirming that the form has been sent to your coach (unless you have pop-ups disabled).

Please confirm whether you are:


What has prompted you to contact Heather Blackmore / Optimal Coaching?

Were you referred to Heather Blackmore / Optimal Coaching? If yes, please say who referred you below. If not, please say how you first heard about us.

What type of organization do you work for?

What industry sector does your organisation fall under?

How would you describe your current role in your organisation? Please include number of direct reports, if applicable.

What is your motivation to seek coaching?

What most frustrates you?

What strengths would you like to lean into?

Describe your ideal life:

In what area of your life do you most want to have a true breakthrough?

What is your vision for your life and/or business for the next year?

How satisfied are you with the level of fun or pleasure you are experiencing in your life?

How would you describe your current general state of well-being, energy and self-care?

Engaging in a coaching process requires time and commitment. At this time, how would you describe your commitment level? Please rate your commitment on a scale of 0-10.

0 = no commitment

10 = I’m fully committed to investing the necessary time and energy.

Please give an indication of your needs in terms of urgency below.

We review requests on a regular basis
and will get back to you as soon as possible.

Please be sure to click on SAVE & SEND when you have completed the form.

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