Full Name *

Email *

Date of birth *

Phone Number *

Address *

How did you hear about me? *

What do you do professionally? Do you enjoy it? *

What is your Job Title or Business Name? *

Please include your primary personal or businesses website URL, if applicable. *

What is your current annual personal income? *

What is your desired annual personal income? *

What are you currently struggling with? Is there anything overwhelming you? *

How is this problem affecting your health, family life, and finances? *

If I waved a magic wand and you could have it any way you wanted, what would it look like? In other words, how would you want your health, relationships, and career/business to be different? *

What do you think is preventing you from getting to where you want to be? *

What are your goals over the next 3 months and what would accomplishing these achievements mean to you? *

What is your current relationship status? Is current situation satisfying? *

What do you think your challenges are in achieving your goals? *

Have you ever received coaching or therapy before? *

If so, who was your coach or therapist? What did you feel worked well or what didn’t you find effective? Did you meet your desired outcomes? *

Do you have spiritual/religious or meditative practice or beliefs? If so please share a bit about. *

Anything else you'd like to share with me before we speak? Or that me knowing could help me help you? *