PERSONAL DEVELOPMENT

INTAKE FORM

This questionnaire allows me to get to know you better and is designed to capture an initial ‘state-of-being’ by self evaluation and personal reflection. Please be completely honest with your responses knowing that this is not to create judgement or negative feelings of self, but to define where you currently are in relation to your desires and beliefs. The more insight I have into your present thoughts, feelings, and beliefs, the more direction and support I can provide.  Write as much as you can in your response. Do not leave an emotion, thought or belief unidentified. This document is a statement of Truth and Intention.  Our intentions carry a very powerful frequency (energy) that affects our daily living. Please be thoughtful and thorough. 

 

The more specific you are with your answers, the better I will be able to help you during our work together.