Liberate Mentorship Intake Form
Name
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First Name
Last Name
E-mail
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example@example.com
IG handle
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Birth information (time, date, location) so I can look up your Human Design
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Who are you? (Please provide some brief info about who you are, where you live/are from, the most important people + things in your life, etc)
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What kinds of personal development, self growth, spiritual exploration, or other work have you done in the past? What did you enjoy most/least about it?
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What is your definition of Liberation?
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What are your top 3 desires/goals within our Liberate Mentorship container?
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What are your big fuck off dreams for your life? (ie. the wild, crazy, head in the clouds kind of dreams)
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What do you believe to be holding you back, blocking, or limiting you from making that happen?
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What parts of your life and creating your vision feel really good/exciting/supportive?
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What areas of your life currently feel sticky/off/unsupportive? (ie. habits, behaviors, repeating cycles, limiting beliefs, emotions, etc)
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When things don't turn out as you expected, how do you typically respond?
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What is your biggest area of challenge right now? (Select all that apply)
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Confidence & conviction to bring them to life
Self-belief (ie. belief your ability to make it happen, if you are as good as you think, imposter-syndrome)
Overcoming limiting beliefs (ie. it feels impossible, doubts)
Current actions and behaviors (ie. social media addiction, procrastination, etc)
Emotions (ie. consumed by/paralyzed by anxiety, fear, etc)
Visibility/ fear of being seen
Energetics (ie. raising your vibration/frequency, balance of doing/being)
Magnetism and attraction
Other
How happy and fulfilled are you in your life overall? (0-10)
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How is your energy level (physical and emotional)?
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How productive are you (life + biz/work)?
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How excited and turned on for life + biz/work are you?
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How tuned into your vision and purpose are you?
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How supportive is the current way you are showing up for your dreams?
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After answering those questions, how do you feel about your mission, purpose, fulfillment, and follow through? Any breakthroughs? Blind spots revealed? Aha moments?
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How willing are you to go all in and show up for yourself to make your dream life turn into your every single day life?
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Is there anything else you would like me to know or to ask me?
How does this choice (making this massive investment in YOU and in creating the life of your dreams) FEEL?
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