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Intake Form


Approximate time: 5min

Filling out this form will save you 30 minutes of valuable breakthrough time!

Please take your time and answer all questions as honestly as you can.

This will allow me to tailor your experience to your unique needs and circumstances.

1. 
What is your timezone?


Alternatively, tell me your city and country, so I can calculate your timezone.
Knowing our time-difference will be helpful when setting session times.

2. 
How satisfying is your life on a scale from 1 to 10, and WHY?


1 is as BAD as it could possibly be. 10 is as GOOD as it could possibly be

3. 
What do you hope coaching will do for you?


Please be as specific as you possibly can.

4. 
What would a successful coaching experience look like to you?


The more specific you can be, the better!

5. 
Is there anything about you I need to know, to understand you better?


Please list anything that is important and unique to you, so I don't accidentally offend or misunderstand you.
i.e: preferred pronouns, drug/alcohol abuse, mental health history, cultural or religious beliefs, etc.

6. 
What is most important to you at this point in your life?


This will help me tailor the session to your unique needs, increasing your chance of a breakthrough.
i.e: fulfillment, financial stability, successful career, emotional mastery, healthy relationships, etc.

7. 
What would you do if you had unlimited resources and were guaranteed success?


Pretend you were handed a magic wand that could instantly give you anything you wished, what would you do with it?

8. 
How would you describe your commitment to the coaching process?

Thank you for taking the time to answer these questions!

Click 'submit' to send me your responses. You will not receive an email confirmation.

What's your name?
What's your email?