Your Om Client Intake

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*Please choose your preferred language of the form (EN | DE) in the top right corner of the screen
*Bitte wähle deine bevorzugte Sprache des Fragebogens (EN | DE) in der oberen rechten Ecke des Bildschirms

Your journey is already starting right here, right now. Every Coaching Journey is completely bespoke for you. Your answers will help me to get a sense of how I can support you during our time together in the best way possible.

I invite you to take a moment to prepare your space for answering the following questions. Make yourself feel comfortable. Do you want to light a candle or incense? Maybe prepare a cup of coffee, tea, or matcha?

This form is infused with loving energy. I invite you to consider it a safe place where you can be completely honest. If you don't feel like answering a question, just add some random letters there. I will treat your answers confidentially and will not pass them on.

Take a deep breath.

Let's start 💜🙏🏽

If you have any questions, you can contact me here:
Mail: lisa@your-om.com
Instagram: https://www.instagram.com/live.your.om/
Telegram or WhatsApp: ‭+4915792368871‬
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Full Name* This field is required.(and what you prefer to be called e.g. Lisa Marie Kuehn, Lisa)
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eMail* This field is required.
example@example.com
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Phone Number* This field is required.e.g +49 15712345678
Country Code
Phone Number
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Time Zone* This field is required.e.g. Time zone in Ubud, Bali (GMT+8)
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Your Birthday and Time* This field is required.If you don't know your time, please insert 0:00
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Your Birth Place* This field is required.
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Instagram Handle & Website (if applicable)
Instagram
Website
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Profession / Working hours per week* This field is required.
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How did you find me?* This field is required.
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Where are you in your life right now? What has led you here?* This field is required.
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How is your living situation right now? Where do you live? Is someone living with you? Do you enjoy this constellation?* This field is required.
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How would you describe your childhood? What was it like? With whom did you live? What memories do you feel are essential to share with me for our time together?* This field is required.
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Please describe any recent life changes.* This field is required.
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Do you have any previous illnesses (physical or mental)?* This field is required.
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On a scale of 1-10 tell me your quality of life right now.* This field is required.
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What do you consider masculine? Tell me anything that comes up.* This field is required.
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What is your relationship to 'the masculine' like? For example, your relationship to giving, assertiveness, confidence, willpower, power, your father, and anything else you consider masculine.* This field is required.
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What do you consider feminine? Tell me anything that comes up.* This field is required.
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What is your relationship to 'the feminine' like? For example, your relationship to receiving, allowing, surrender, receptivity, sensuality, beauty, your mother, and anything else you consider feminine.* This field is required.
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What are the top 3 - 5 values you want to live by? Why these?* This field is required.Mine are ease, freedom, intuitive flow, self-experience, and trust.
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What do you know you're currently believing that is no longer serving you?* This field is required.
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What do you believe about the human experience? Why are you here? What is life really about?* This field is required.
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What is your relationship to your body like?* This field is required.
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What is your relationship to your soul like?* This field is required.
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Do you feel connected to your intuition and your heart currently? Describe the connection as it is now, and how you'd like it to be.* This field is required.
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Have you worked with a coach and/or psychotherapist before? Tell me about the experience...* This field is required.
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What is it that you wish support with?* This field is required.Maybe it's a specific situation in your life or a general theme.
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If it was your soul answering now, what would she want to add to your previous answer?* This field is required.
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What do you most hope will happen as a result of our work together? Please detail desires that you feel comfortable sharing. And also desires that feel uncomfortable.* This field is required.
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Why in particular are you drawn to working with me?* This field is required.
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Is there anything else you would like to tell me that you consider important for our time together?* This field is required.
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