Confidential Pre-Call Questionnaire
Hello and welcome! I'm so happy you’re reaching out, and I look forward to connecting with you. To prepare for our session please answer the following questions. This will help me understand you better, and how I can best serve you. Some of these questions will take you deep. Please know that everything you share with me is confidential. When the form is complete you’ll receive a link to my online scheduler.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Please tell me a little bit about your present circumstances and what caused you to reach out at this time?
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How did you hear about me, or who referred you?
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What do you identify as being your biggest challenge or struggle in relationship?
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What do you most need in terms of tools and support to breakthrough these barriers?
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What have you tried in the past? Did it help - how or how not?
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If you had a magic wand and could change one thing in your life or relationships, what would it be?
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What would that change mean for your life, your future, and well-being?
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On a scale from 1-10, (1 = "I’m not ready," 10 = "I'm all in!") how ready are you to invest in your transformation?
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I'm not ready
1
2
3
4
5
6
7
8
9
I'm all in!
10
1 is I'm not ready, 10 is I'm all in!
Is there anything else you’d like me to know?
Submit
Should be Empty: