Meet Dave Heinrich -- The Encourager

About You

You’re here.
What do you want?
What do you hope to gain through your life tutoring?
What are you looking to achieve through this particular experience?
So that we can serve you better, tell us a little
about yourself right here on this quick questionnaire!

Answering these few questions thoughtfully and truthfully will help Dave to help you most effectively.

Your Name:

Address:

Email:

Best Phone Number to Contact You (include Area Code):

1) In what area of your life do you want encouragement and tutoring?:

2) On a scale of 1 to 10, with 10 being the “most open”, how open are you to new ideas and actions that may facilitate the improvement that you are looking for?

3) Are you ready to take responsibility to move forward if you receive sincere encouragement?

4) What time commitment are you willing to make to life tutoring so that you can be encouraged to move forward?

5) What specific goal would you like to achieve, first, with the help of this encouragement?

6) Where did you hear about Dave?	A friend USA Today Online USA Today Newspaper Link from another website Yahoo! Google ASK.com MSN.com Magazine; which one: Other newspaper; which one: OTHER:

Best Time to Call:	11am-2pm EST	2pm-5pm EST	5pm-8pm EST
	8pm-10pm EST	10pm-Midnight EST

Upon Dave’s receipt of your submission, he will contact you within two business days for a Free, brief personal introduction and to setup your first session, should you both make the decision to go ahead.