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First and Last name
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Your answer
Client email
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Your answer
Birthday
MM
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DD
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YYYY
Today's date
MM
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DD
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YYYY
How many people live with you?
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What is your current living situation (married, separated, roommate, etc)?
Your answer
Do you have any children? If so, what ages?
Your answer
What is your daily schedule like currently?
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What is your ideal daily schedule?
Your answer
If you had all the money you could ever need, what would your life look like?
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Who are the people you consider to be supportive of you?
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What are some goals you have always wanted to attain but never have?
Your answer
What are your best qualities?
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What do you feel are your worst qualities?
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How can I help you in the next 30 days?
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What is your spiritual or religious affiliation?
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Do you feel comfortable taking a few deep breaths leading into a session?
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How would you describe your ideal relationship?
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How would you like me to handle situations where you may not be completing your assignments or standing in your power (tough love, sensitively, etc.)
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