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1 on 1 Client Application
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Email
*
Your email
Full Name (First, Middle, Last)
*
Your answer
Phone Number
*
Your answer
Instagram Profile Link
Your answer
Facebook Profile Link
Your answer
Linkedin Profile Link
Your answer
Website Link if Applicable
Your answer
What is your current business or career?
Your answer
What is calling you to work with me? What areas in your life would you like guidance and assistance? Spirituality, Love Life, Career, Physically, Health, Purpose?
Your answer
What do you desire more than anything right now?
Your answer
Do you have any health issues past or present? Are you taking any prescription medications? Please explain.
Your answer
What are your top 3 accomplishments you have achieved in your life? How did you learn and grow from these and why do they make you feel proud?
Your answer
Do any of these fears resonate with you at the moment?
Fear of the Past: When you fear that the past will repeat itself so you don't take action at all. (44)
Fear of Tomorrow: When you fear that you won't have what you need in the future, so you don't live in the present moment because you are worried about tomorrow. (57)
Fear of Inadequacy: When you feel you won't know how to do something so you don't take action. (48)
Fear of Authority: When you feel that nothing is finished until it's perfect so you don't launch it into the world. (18)
Fear of Death: When you feel like life has no purpose and its to hard so why do anything anyways. (28)
Fear of Failure: When you feel you don't have enough resources to accomplish what needs to be completed (32)
Fear of Responsibility: When you feel fear to commit to the people and opportunities of life. (50)
All of the above
None of the above
Other:
Have you worked with someone in this way before? A therapist, life coach, mentor, psychic or spiritual healer? Was it one on one or a group container? Please share your experiences.
Your answer
Yearly Income
*
Less then $100,000
$100,000 - $200,000
$200,000 - $500,000
$500,000 - $900,000
$1 million +
$100 million +
$1 billion +
I would like to work out a payment plan with you.
Other:
Is there anything else you feel inspired to share? Good, bad, ugly, anything goes here.
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Comments and/or questions
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