Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Re-Imagine Your Next Chapter - Sign Up Questionnaire
Thank you for signing up. Before I email you the course specifics, I would love to learn more about you and your work. If you are open and willing to share please respond to the questions below. I will be in touch about next steps.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
What is your occupation? ( Job title eg Digital health leader, Solopreneur, Health practitioner e.g. Acupuncturist)
*
Your answer
How did you hear about my work? (Most of my work comes from referrals so please name the person or community - so that they can be thanked - or please list search term you used)
*
Your answer
What identities do you happily associate with?
*
(
e.g. ambitious, minimalist, multi-passionate, neurodivergent, sensitive, Ennea type
)
Your answer
What is your most important work goal this year?
*
Your answer
Why is this particular goal important to you right now?
*
Your answer
What are your biggest challenges with obtaining this goal?
*
Your answer
What will obtaining this goal allow you to be, do and/or have?
*
Your answer
What kind of support would be most beneficial for you in achieving this goal?
*
(For instance: small accountability groups, self study to work through, 1:1 guidance or whatever else comes to mind)
Your answer
What is your timezone?
*
Your answer
Please share anything else with me you feel is relevant.
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
