Soul-Aligned Success: Client Intake Questionnaire

Soul-Aligned Success: Client Intake Questionnaire

Thank you for your interest in the Soul-Aligned Success programme. Please take a few moments to fill out this questionnaire. Your responses will help me understand your current situation, goals, and whether this programme is the right fit for you. I will contact you to schedule a discovery call in November, when I return from maternity leave, with the programme starting in January.
Important:

Please review the programme outline and investment at samburgess.uk/soul-aligned-success before completing the form. Coaching calls take place on Tuesdays and Wednesdays between the hours of 10am and 4pm GMT. Unfortunately I am not able to accommodate outside of these days/hours.
Personal Information:
Full Name*

First NameLast Name
Email Address - please double check!*
example@example.com
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current Business Status:*

I am running an established businessI am in the process of starting a businessI have a business idea but haven't started yetOther (please explain)
Other, please explain here:
Business Name (if applicable):
Briefly describe your business (or business idea):*
How long have you been in business?*

Not started yetLess than 1 year1-3 years3-5 yearsMore than 5 years
What industry or niche does your business operate in?*
Goals and Challenges
What is your primary goal for your business in the next 12 months*
What is your biggest challenge or frustration in your business right now*
Which areas of your business do you feel are most misaligned or in need of support? (tick all that are applicable)*

Business strategyMarketing and client acquisitionTime management and work-life balanceFinancial growth and profitabilityMindset and overcoming limiting beliefsOther (please specify)
If other (please specify)
What would success look like for you if you could overcome these challenges?*
How do you feel about the current balance between your work and personal life?*
Are you familiar with Human Design?*

I've heard of it but that's allNot at all, I don't know what it isYes, I have some understanding and have pulled my chartYes, very familiar. I've had a reading/or am a practitioner
Please can you provide your date of birth, DD/MM/YYYY, place of birth (City and Country) and time of birth HH:MM so I can view your chart.*
Readiness & Commitment
Why are you considering coaching now? What prompted you to reach out?*
Have you worked with a coach before? If so, what was your experience?*
On a scale of 1-10, how committed are you to making significant changes in your business and life?*

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
How much time per week can you realistically dedicate to this programme?*

1-2 hours2-3 hours3-5 hoursMore than 5 hours
Have you reviewed the investment (£3,000 GBP)? Are you ready to invest financially in your personal and business growth?*

Yes, I am ready to invest and pay in full.Yes, I am ready to invest and would like to opt for the payment plan of x3 £1,100 GBP payments.I’m not sure yet, I’d like to learn more
Are you available to start coaching in January 2025?*

YesNo, but I'd like to discuss future dates
Additional Information:
What are you hoping to gain from working with a coach?*
Is there anything else you would like me to know about your business or personal situation?*
Do you have any specific questions or concerns that you’d like to address during the discovery call?*
How did you hear about me? *
Thank you for providing this information.

I will review your responses and be in touch to schedule your 30-minute discovery call in November. I look forward to exploring how we can work together to create a soul-aligned business that supports the life you desire.
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Soul-Aligned Success: Client Intake Questionnaire

Important:

Personal Information:

Goals and Challenges

Readiness & Commitment

Additional Information:

Thank you for providing this information.