Phone Email * Date of Birth: Life Assessment - rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest): Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 1 2 3 4 5 6 7 8 9 10 Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 1 2 3 4 5 6 7 8 9 10 Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 1 2 3 4 5 6 7 8 9 10 Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? 1 2 3 4 5 6 7 8 9 10 Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals? 1 2 3 4 5 6 7 8 9 10 Health: I feel that my overall physcial and emotional health (my well-being) is primed and optimized to make me feel energetic, motivated and strong each day. 1 2 3 4 5 6 7 8 9 10 Lover: I feel a consistently deep, trusting, appreciative, soulful, loving connection with my significant other. I am patient, respectful an attentive to my partner’s needs. 1 2 3 4 5 6 7 8 9 10 Family and Friends: My immediate social circle of family and friends brings connection, fun and positive energy into my life. I seek out positive people and I do my very best to bring positive energy and real authenticity into all my relationships. 1 2 3 4 5 6 7 8 9 10 Finances: I have the level of abundance I need to have a stable income and lifestyle I desire for myself and my family. I earn and invest at the levels I had hoped at this time in my life. I have a clear vision for improving my finances and lifestyle in the next few years. 1 2 3 4 5 6 7 8 9 10 Hobby: I have a passionate past-time that allows me to express, enjoy or develop myself outside of my job/career. I give enough time to the things I love in life. 1 2 3 4 5 6 7 8 9 10 Your doing great! - Let's go a bit deeper. (Filling this in will help you get the most out of our time together) If you are unclear/uncertain how to answer any of the following questions just fill in * What do you do for a living, and why did you choose that career? What are your top 3 goals you are striving to achieve right now? What major stressors or challenges are you struggling with right now? What would your dream life look like if you could wave a wand and make it happen? What has prevented you from having your dream life? What 3 big changes would you like to make in your life in the next 12 months? What negative recurring thoughts, fears, or behaviors would you like to overcome in order to feel more psychologically free, confident and successful? What distracts you the most from being more productive, and what major projects or missions are you struggling to complete faster or more efficiently? How purposeful do you feel in living each day, and how would you describe your purpose? What would it mean to you to get rid of any blocks holding you back from reaching your dreamlife? GDPR Agreement *
Your data is very important to us and will be handled in the most private and secure way possible.