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MMT Coaching Intake Form
Mountain Mind Tricks Is committed to the well-being of your mind, body and spirit. I will help you maximize your life on every level. Please fill out this intake form, so I can get a snapshot of why you want a life coach.

"Most of us have two lives. The life we live, and the unlived life within us. Between the two stands resistance."
~The War of Art~

Thank you for choosing Mountain Mind Tricks!
Email address *
What is your biggest challenge right now?
Your answer
Why are you interested in working with a life coach?
Your answer
What is your full name? *
Your answer
What is your birth-date? For generating a Numerology Report.
MM
/
DD
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YYYY
How did you find out about Mountain Mind Tricks?
On a scale of 1 to 10, how happy do you feel everyday?
Depressed
Ecstatic
On a scale of 1 to 10, how satisfied are you with your life?
Not Satisfied
Satisfied
On a scale of 1 to 10, how well do you manage your time?
Poorly
Perfectly
On a scale of 1 to 10, how much time do you get to spend doing your favorite recreation?
Never
Everyday
On a scale of 1 to 10, how would you rate the health of your mind, body and spirit?
Sick
Healthy
Do you feel safe with your income?
What would your perfect income look like?
Your answer
What result do you want at the end of our coaching term?
What are your challenges in life?
Your answer
On a scale of 1 to 10, what is the amount of stress you experience every week?
Low
High
On a scale of 1 to 10, what is the quality of sleep you get each week?
Terrible
Perfect
On the scale of 1 to 10, do you eat a healthy diet?
Fast Food
Organic everything
What would your perfect day look like?
Your answer
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