Belief Alchemy Experience Intake Questionnaire

Belief Alchemy Experience Intake Questionnaire

Belief Alchemy Experience Intake Questionnaire – upon scheduling (10–15 Minutes | Deep Preparation). Purpose: Help identify the beliefs, patterns, emotions, and desired outcomes that will shape the Belief Alchemy Experience.
Name

First NameLast Name
What area of your life feels most challenging right now? (Choose up to 3)

Other (please describe)
Which thoughts do you find yourself thinking most often? (Choose up to 10)
Which of these statements resonate most deeply? (Choose up to 5)
What emotions do you experience most frequently? (Choose up to 5)
What would you most like to experience instead? (Choose up to 5)
If this experience were wildly successful, what would be different in your life?
What challenge, pattern, belief, or situation feels most important for us to explore together?
On a scale of 1–10, how ready are you to release old patterns and embrace meaningful change?

1

2

3

4

5

6

7

8

9

10

1 is 1 = Curious, 10 is 10 = Fully Committed
Is there anything else you’d like me to know before our Belief Alchemy Experience?
Should be Empty: