Disrupt PAY WHAT YOU CAN - FINANCIAL COACHING

Disrupt PAY WHAT YOU CAN - FINANCIAL COACHING

Use this form to map your current financial reality, your patterns, your nervous system, and your goals.Your honesty matters. Your answers shape the plan I build for you.
Thank you for saying yes to this.

Please complete this questionnaire.
Your plan will be based entirely on the answers you give here, so take your time and be honest.

Once all three steps are done, I will begin creating your personalised money plan.

This questionnaire is the real starting point. Before we change anything with money, we need clarity. Not guesses. Not stories. Actual clarity.

This form helps me understand how you earn, spend, save, avoid, and cope.
It shows me your patterns, your shadows, and the way your nervous system responds to money.

It also shows me what you want, what stops you, and what needs to shift.

There is no judgement here. Everything you share here is strictly confidential.
Money can bring up shame, fear, avoidance and a lot of emotion.

I get it. I work with this every day, and nothing you say here will surprise me.
Just data, patterns, and truth.

The clearer you are, the more accurate and useful your plan will be.
Take your time. Go slow. Be honest.

IMPORTANT

Please ensure every answer and all relevant information are included in this questionnaire before submitting it.

Any additional information sent separately by email, Instagram or another platform after I have started your game plan will incur an additional fee of $75. This is because reviewing new information, revisiting your answers and adjusting work already completed increases the time required to prepare your plan. These plans take me anywhere from 3-4 hours.

Your game plan will be created from the information provided in this questionnaire, so please take your time and make your answers complete.

After you have completed this,

Let’s begin.
Name

First NameLast Name
Email
example@example.com
Social Media
Location/Time Zone
What made you say yes to this offer today?
SECTION 1 - ABOUT YOU
What do you do for work or business right now? How long have you been doing this?
Rough monthly income after tax
Relationship status?
Do you share money or financial responsibilities with anyone?

SECTION 2 - YOUR CURRENT MONEY REALITY
Average monthly spending (Fixed bills & Variable spending)
If you have savings and investments please list here:
List all debts with balances, interest rates and minimum payments:
Do you pay bills on time or last minute. Explain:
How clear are you on your numbers
Is your current environment supportive of healthy financial habits? Why or why not?

SECTION 3 - HABITS AND PATTERNS
If I opened your bank account right now, what would I see you spending the most money on?
Out of everything you spend money on, what actually feels worth it? The purchases that match your values, improve your life, or genuinely matter to you. Examples: therapy, gym, quality food, kids’ activities, travel, business growth, education.
What do you spend money on that does not feel worth it when you look back. These are the things that keep you stuck, feel impulsive, or give short-term relief. Examples: Uber Eats, late-night online shopping, high grocery costs from not planning, Afterpay, emotional spending, subscriptions you never use.
What do you tell yourself to justify purchases you know are not aligned. Examples: “I deserve it”, “I’ve had a long week”, “It’s only $20”, “I’ll be better next month”, “I’ll deal with it later”.
What values do you want your spending to reflect. For example: health, stability, fun, family, financial growth, freedom, simplicity, discipline, purpose.
When you look at your spending, what feels out of alignment with the life you wantBe honest. This one usually reveals the whole pattern.
When you feel stressed, how does it show up with money
Where does your money seem to “disappear” the most(Examples: eating out, groceries, shopping, Afterpay, kids, subscriptions)
How often do you look at your bank accounts and audit your spending?
Share one money decision you wish you handled differently. Describe the situation/feeling before the purchase and what you think the driving factor was and how you felt after the purchase.
Share one money decision you feel proud of:

SECTION 4 - EMOTIONS AND NERVOUS SYSTEM
Describe your current emotional landscape when it comes to money. As in, the feeling you experience the MOST.
Do you tend to spend too easily, spend too cautiously, or jump between both?
What did you learn about money growing up? What was modelled to you about spending, saving, talking about money.
Are stress, burnout, dysregulation or mental load affecting your money habits?
What part of your money behaviour feels the most confronting to admit?
When you sabotage your goals, what triggers it? (Stress, loneliness, boredom, pressure, comparison, burnout?)
What story from childhood still shapes how you handle money now? It can be a sentence, an incident, or a memory.
What identity do you cling to that keeps you stuck with money? Examples: “I’m bad with money”, “I can’t save”, “I’m an avoider”, “I’ll handle it later”, “I’m just not disciplined”.
What part of you benefits from staying confused with money? (Every pattern has a payoff. Name it.)
What do you fear would change if you became truly good with money?
When you imagine being financially stable, what feels uncomfortable about it?
What’s the belief you know is holding you back but you still operate from anyway?
What is one money pattern you would be embarrassed for someone to see?
What emotion shows up in your body when you think about changing your financial patterns? Name the sensation and the feeling.
If your money patterns were a person, how would you describe their personality?
When life gets stressful, what happens to your spending? Spike, freeze, avoid, tighten, ignore?
How do you usually make money decisions? Fast, impulsive, slow, avoidant, emotional, logical?
Who relies on you financially? How does this really make you feel?
What makes you hesitate or delay financial decisions the most?
What’s your biggest fear when making money decisions?

SECTION 5 - Capacity + Lifestyle Realities
What’s your current energy level day to day? (Low, medium, high?)
Are you dealing with mental health challenges, diagnosed ADHD, burnout, or chronic stress that affect your capacity?
How stable is your current lifestyle? (Routine, chaotic, unpredictable, seasonal?)
What time, realistically, can you commit to money tasks weekly?

SECTION 6 - Money Identity Mapping
Who taught you your earliest money beliefs and where do you still operate from them?
Which money identity do you relate to most?
How does this identity show it self?
Which money identity do you want to grow into? As in, tell me how you desire to feel and be when it comes to money.

SECTION 7 - Money + Nervous System Connection
What sensations show up in your body when you open your bank app?
How do emotions influence your spending? This includes high emotions as well as low ones. For example, spending when you feel sad, bored, stressed, excited, proud, or when a windfall arrives.
Who do you become when you feel out of control with money
Who do you become when you have more money than you're used too? Example, tax time, inheritance etc. What happens?
What feels uncomfortable about stability or consistency?

SECTION 8 - LIMITATIONS AND NON-NEGOTIABLES
What are your non-negotiable expenses each month? The things you will not remove or cut back, no matter what. Examples: rent or mortgage, medication, kids activities, fuel, therapy, gym membership, specific food needs, childcare, pets, business software you rely on etc.
What could you reduce or cut back on if needed. Not forever, but temporarily, if it meant getting ahead. Examples: eating out, drinking, online shopping, Uber Eats, beauty appointments, subscriptions, clothing, weekend activities, gifts. List what feels realistic for you.
What money habits or systems do you know you cannot stick to. This helps me avoid giving you a plan that sets you up to fail. Examples: strict daily budgeting, checking accounts every day, tracking every single purchase, extreme saving rules, no-spend weeks, using 10 different accounts, heavy spreadsheet systems, complicated financial apps. Be honest about what does not work for you.
What DO you know you can stick to easily? Examples: weekly check-ins, simple category limits, automation, one clear savings goal, one debt at a time, bi-weekly money dates, tracking only the big things, using reminders etc.

SECTION 9 - YOUR MONEY GOALS AND DIRECTION
What is the number one money problem you want solved first. The thing that would give you the biggest relief right now. Examples: stop overspending, clear debt, build savings, emergency fund, understand my money, stop avoiding, get structure.
What is the one financial change that would make your life feel lighter within the next 30 days. Short term. Practical. Immediate. Examples: knowing your bills, having a simple plan, tracking once a week, stopping impulse spending, organising accounts.
What are your top three money goals over the next 12 months. Be specific, even if you feel unsure.
What does “financial stability” look like for you in simple words.
If you could only achieve one money goal this year, which one matters most and why?
What habits do you want to be known for with money?
What obstacles do you already know will come up when working toward these goals. Call them out now so I can design around them.
Finish this sentence: If this plan worked better than I expected, my life would feel…
Should be Empty: