YLWBUG® Individual Client Intake Questionnaire
Your Transformation Starts Here
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Role / Title
Industry or Field
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Y™ — YOUR PURPOSE (The Root)
Understanding your "why" is the foundation for meaningful change.
What's the change you're ready to make
*
This could be career, personal, relational, entrepreneurial — wherever you feel the pull.
Why does this matter to you personally?
*
I’m seeking greater alignment between my work and my values
I want to make a more meaningful impact
I’ve outgrown my current role or situation
I’m navigating a major life or career transition
I want to build or realign my business with my authentic purpose
I’m seeking better balance between my work, relationships, and personal well-being
I want to build something that reflects who I really am
Other
Complete this statement: “Success for me means...”
*
Think beyond titles or timelines — what would success feel like?
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O™ — YOUR JOURNEY (The Circle)
Transformation is a process, not a moment. Let’s understand where you are.
Where are you right now in your journey?
*
Exploring— I know I need a change but haven’t started yet
In motion — I’m actively working through a transition or challenge
Refining — I have direction but need sharper strategy or support
Elevating — I’m established but ready for the next level
Have you worked with a coach, consultant, or advisor before?
*
Yes
No
What are you hoping to experience differently this time?
What feels most urgent right now?
*
Clarifying my next move — career, business, or life direction
Strengthening how I present myself professionally (resume, interviews, brand)
Developing my leadership presence and confidence
Navigating a difficult transition or challenge (career, personal, or both)
Aligning my work, life, and relationships with my deeper sense of purpose
Ensuring my business reflects my values and supports sustainable growth
Something else
Please describe.
What does your ideal life look like one year from today?
*
Where would you like to be — personally, professionally, or both?
What’s your timeline for addressing your current needs?
*
Immediate (within 30 days)
Short-term (1–3 months)
Medium-term (3–6 months)
Long-term (6+ months)
Flexible — depends on the right fit
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U™ — YOUR COMMUNITY (The People)
Transformation doesn’t happen in isolation. Let’s talk about your support system.
Who are the most important people in your life right now — personally and professionally? Check all that apply.
*
Manager or supervisor
Mentor or sponsor
Colleagues or team members
Clients or customers
Business partner(s)
Family or personal supporters
Faith or spiritual community
Professional network or industry peers
I don’t feel I have a strong support system right now
Other
How supported do you feel in pursuing this change?
*
Feeling mostly on my own in this
1
2
3
4
5
6
7
8
9
Fully supported and championed
10
1 is Feeling mostly on my own in this, 10 is Fully supported and championed
What’s your biggest relationship or communication challenge?
*
Advocating for myself in professional or personal settings
Building or rebuilding my professional network
Communicating my value clearly to employers, clients, or partners
Navigating a difficult dynamic with a manager, partner, or colleague
Strengthening the relationships that matter most to my growth
Finding the right mentor, community, or circle of support
Other
SERVICES & PARTNERSHIP DETAILS
Let’s explore how we might work together.
What type of support are you most interested in?
*
Career strategy and transition planning
Resume, interview, and professional branding
Leadership development and executive coaching
Personal transformation and purpose alignment
Wellness and life design — aligning work, relationships, and well-being
Entrepreneurship and business alignment — building or realigning a venture with your purpose
YOU™ Performance Assessment (individual insights)
Not sure yet — I’d like to explore options
About budget: this helps us recommend the right support for you. It isn't a commitment, and "Not sure yet" is a fine answer.
What's your approximate budget range for this work?
*
Under $500
$500 – $1,500
$1,500 – $3,500
$3,500 – $7,500
$7,500+
Not sure yet — I'd like to talk it through
How do you prefer to work with a transformation partner, coach, or advisor
*
Hands-on collaboration — working closely together throughout
Strategic guidance — high-level direction with me executing
Structured program — a defined process with clear milestones
Flexible — adapting as we go based on what I need
FINAL REFLECTION
What drew you to consider working with YLWBUG®?
*
Help us understand what resonated with you about our approach
How did you hear about us?
*
Tony Sawyers Career Support
Referral from someone I trust
Social media
Website / search
Networking event
Direct outreach
Other
Is there anything else you'd like us to know before we connect?
Submit My Intake
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