Name * First Name Last Name Email * Phone (###) ### #### Subject * Message * Emergency Contact * *although my intention is this is NOT needed please provide an alternate way that I can reach you or your loved ones in an emergency scenario. Strengths Finder Take your time in answering the following questions. Keep a copy for yourself, and always know – what is shared here, is shared for us to use in support of your growth. Nothing will go beyond our conversations without complete agreement from us both. Yourself: Describe yourself What do you love most about your current life? What do you love least about your life? What are your current top 3 biggest life challenges and why? Describe as best as you can your week daily routine? weekend routine: What are you currently focusing your energy and attention into bettering during the next 4 months? Describe your IDEAL DAY: List 3 short-term goals you would like to work on with measurable results for each over the next 30 days (Hint: keep these simple) List 3-6 more goals you would like to work on over the next 6 months with measurable results for each. (Hint: this is the time to stretch yourself!) What would you like your life to be like 12 months from now? DREAMING BIG FOR SURE ON THIS ONE ;-) What do you think is holding you back or has slowed your progress up to now (resources, understanding/knowledge of new tools, friends, family, mentors, inner mindset)? If you could change ONE thing in your life right now- what would it be ?*(Hint – don’t overthink on this one – go with the first thing that pops into your mind.) What is the biggest opportunity/resource that you’re not taking advantage of? What are the negative things you typically tell yourself? (Make a list, please.) What do you desire as your MAGICAL Leap in life for the next 4 months: Results are an issue of personal responsibility simply signing up to work together is no guarantee that you will achieve results. BUT please know I am committed to your progress, and need you to do the same for yourself. Are you ready and willing to make the changes necessary to achieve your goals? Yes How do you want me to support you, if I notice that you are falling off track? (I’m always loving... no worries!) What is the most empowering and helpful thing I can do for you during our time together? Hooray! You have already completed one of the most important steps to reaching the next level in your life! Give yourself a pat on the back and go celebrate. A note about me : I work best with those who are willing, rather than those who doubt or resist everything. What it comes down to is: I truly want the best results for you out of our work. Do I have permission to gently call you on using excuses, avoiding, resisting recommendations if I see it happening? Yes Thank you!
