Money Breakthrough Session Clarity Form

Date

MonthDayYear

Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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Thanks so much for your interest in addressing your Money Blocks. In order to make sure that I can serve you, and you get the most out of our time together, please answer the following questions: this text...

1. Have you ever been coached/had a coach before? If so what was your experience? what worked and what didn't work?

2. What would you like to change about your relationship with money? What is your motivation to change?

3. How committed are you to taking action steps to change your situation and/or reach your goal? 1-not committed and 10-completely committed and ready

4. What are your expectations from me as a coach, what would you like to gain from our sessions together should you choose to move forward with coaching?

5. Do you consider yourself Spiritual? If so, please describe your spiritual beliefs.

6. What else have you tried in the last few months and years to improve your situation? (with money and how it effects your life)

7. When you are faced with money challenges and/or problems, how do you usually solve them? How do you react?

8. What do you see as your main source or sources of stress? Money or otherwise.

9. Are you willing to invest time and money for support with your transformation?

10. Have you been diagnosed with any Mental Illness? If so what is the diagnosis? What if any medications are you taking?

11. What if anything would get in the way of you moving forward with receiving support?

***Know that whatever you share with me is confidential. I do not share the information with anyone unless I seek support from my mentor.