Tell Me About Yourself

This 5 Minute Background Form is Required

Your appointment is not confirmed until we receive this. If we do not
receive your completed background information within 12 hours, we will cancel the appointment.
Please do that right now!

Complete this form now!

Please fill out this required application as completely and as accurately as possible.
We get a LOT of applications for the available calendar slots and can only take the candidates who are the very best fit for the high level coaching environment in BREAKTHROUGH.

Application must be completed within 12 hours or your session will be cancelled.*

*If you are rescheduling an appointment and have already filled out the application, you may skip this step.




For each category, indicate how SATISFIED you are today: