Free Sessions Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This is an application form for 4 free 30 minutes coaching sessions with Anita.

Email *

Name and surname *

Date (DD.MM.YYYY), time (HH:MM) and place of birth. *

(l will use this to see how you work best according to Human Design )

Phone number *

What is your reason apply? *

I know what I want in life and I am willing to do what it takes to get it.

I am on the point where I know my life could be better, yet I don't know exactly how to get there. I am aware that I have blind spots..

I tried everything, now I want to try coaching as well.

A friend recommended me coaching experience with Anita

Other:

Required

Did you ever work 1:1 with a coach before? *

Yes

No, but I was part of group coaching.

Other:

Fill in if you your response to previous Q was "Yes": What did you like about your coaching and what not? What would you need more/less of?

Where do you see yourself one year from now?

What do you want to create? What are your long term goals? What do you see as worthy of your investment of time-energy-love-money? What is the thing that will make you completely satisfied on your death bed that you invested your life in it? *

How far are you on your journey of creating what you really want in your life? *

I don't even know what I want.

I am on my way, moving every day.

What steps did you already take in the direction of your dreams? *

How committed are you to following through with your vision? *

I usually quit very fast.

I am 100% committed, nothing can stop me.

How will coaching help you with that? What are your intentions? How will you make the best use of our time together? *

What usually comes between you and your dreams? Where do you have most of your pain points? *

Relationships

Health

Finances

Job / Business

Self image

Lack of meaning

Other:

Required

What is your favourite way of sabotaging yourself? (Procrastination, analysis paralysis, finding a problem for every solution before even trying it out, creating drama in relationships, over-giving and burning out, isolating yourself, serial health problems, blaming others instead of looking for solutions, not seeing a point anymore, quitting...) *

How willing are you to overcome your self sabotaging patterns of behaviour? *

This is just the way I am, I cannot change that.

Very committed. I love testing out new ways of being and doing. Those that I enjoy soon become my good habits.

How much are you currently willing and capable to invest in coaching and personal growth? *

$ 500 000 per year and more.

$ 100 000 per year and more.

$ 30 000 per year and more.

$ 5000 per year and more.

Less than 5000 per year.

Less than $ 1000 per year.

I am currently not able to financially invest in my growth. I am willing to invest time, energy, love. I am 100% committed to heal my money traumas and improve my financial situation.

I am not willing to invest in myself.

Other:

What insights about yourself did you have while filling in this application form? *

Is there anything else you would like me to know?

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of anitapuksic.com. Report Abuse

Forms