Preliminary Questionnaire                             
Hi, I'm Roxana. I'm grateful to connect with you and for your interest in working together!

Welcome to your Discovery Session, which starts here with our preliminary questionnaire.
I’ll tell you a little bit about what to expect before we get started.


1. Over the course of our call we're going to discuss in a little more depth about where you’re getting stuck and what it would look like if you didn’t get past that obstacle.

2. Then I’m going to ask you about your commitment to moving forward and I’d love to hear what your vision for yourself is.


If it looks like a fit for us to work together I will make some recommendations based on what you share with me.


In any case, this is a great opportunity for you to speak about the matter with a fresh mind that is impartial towards your situation, be that about your personal or professional life, or about your team.


Everything starts with you, and that's why these questions are about you.


So, in order to make the most of your time during the Discovery Call, and to help you create the most accurate Custom Blueprint, take a deep breath, tune into yourself and complete the questionnaire below!




I look forward to meeting you!

Roxana
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Email *
Name *
Where are you based? (& time zone)
YOUR OBSTACLES
Tell me a bit about your current problem
*

What is your biggest obstacle, or your top 3 obstacles in moving forward with the above situation?

 *
COST OF STAYING STUCK 

Imagine for a moment that you don’t get past these obstacles. What is that going to look and feel like in your life? What would be the cost to you, including financially? 

Identify the costs in as many aspects of your life as you can think of: 

Physical

Emotional

Financial

Health Wise 

Relationships and community

Why do you think you are stuck this way? 

 *
YOUR VISION

If you could wave a magic wand or snap your fingers and solve this problem immediately what is your vision? What would your ideal life/work/health etc. look like? 

Be as specific as possible about describing the details. Pretend for a moment that you’re inside your perfect fairy tale and forget about any limitation as to what is possible. What would you actually want if you thought you could have it? 

 *

COMMITMENT

On a scale of 1 - 10, with 1 being the least committed and a 10 being fully committed, how committed are you to getting past your obstacles? (That includes your willingness to invest in both time and money)

 *
What is your current occupation?  *
In which range does your salary fall? *
Required
If you chose to work with me, when would you want to start?
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Is there anything else you would like to share? Anything you are feeling around concerns, goals etc? 
A copy of your responses will be emailed to the address you provided.
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