Free Breakthrough Session Form

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Please confirm your Full Name* This field is required.
First Name
Last Name
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Please confirm your Email Address* This field is required.Please ensure you use the same as given in the appointment booking
example@example.com
Confirm Email
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And lastly, please confirm your Phone Number* This field is required.
Please enter a valid phone number.
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Were you referred to Karolyn.Live? If so by whom?
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I want to improve...* This field is required.
My own personal development
The relationship between me and my teen
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What are the main problems that are showing up in your relationship with your teen?
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In an ideal world what would your relationship look like?
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What do you feel is your #1 biggest obstacle right now that’s preventing you enjoying a relationship with your teen?
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Use the following to describe where you’re at:
Been to counseling & the relationship is going ok, but feel we need a boost
Tried counseling but it didn’t make any difference
Realize that I need to do something but unsure what that looks like
Nothing yet
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How long have you been struggling with your relationship with your teen?
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How old was your child when you noticed a marked difference in your relationship?
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Which of the following best describes you?* This field is required.
I have access to my own financial resources and can make my own financial decisions.
My spouse/partner and I make financial decisions together. I can make a decision, but I would need to check with them first, or at least let them know.
I don’t have any access to financial resources; my spouse/partner controls everything and I can’t make any kind of an investment without their permission.
I don’t have any financial resources at all and I am going to stay exactly where I am.
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Will you attend our scheduled appointment on time and be distraction free?
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In a few words, what would you like to explore during the Breakthrough Session? Please include your main concern.
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Are you currently or have you recently gone through one or many of these life changes:
Relocation across states or borders
Job loss for various reasons
Retirement
Significant birthday milestone
Health warning
Shift in your life relationship: Divorce / Separation / Newly-Wed / Other
Other
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Which of the following best describes how you feel about your current life status?
I'm excited to embark on a new life journey and am looking for support and accountability as I navigate my way forward.
I feel stuck and need guidance realigning and finding that higher version of myself.
I'm at a crossroad and unclear of which direction would serve me best.
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What is your willingness (scale 1-10) to commit the time and invest in transforming your current state of wellbeing?
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Please Select
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1
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Right now I…….
Have the financial resources (lower-four figures) to invest in putting me on a fast track to Realigning my Brilliance.
Have access to the financial resources (lower-four figures) to invest in putting me on the fast track to to Realigning my Brilliance.
Have the financial resources to invest in a 3-month payment plan that will ensure that I Realign my Brilliance.
I don’t have any financial resources at all and I am going to stay exactly where I am.
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Is there anything else you would like to share before we embark on our Free Breakthrough Session?
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Finally, on a scale of 1 to Marilyn Monroe, how awesome are you?
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