OptiMOM Coaching Initial Intake Form

These initial questions will give us a frame to build your work on. I encourage you to be as transparent with yourself and with me as you can. A lack of honesty will always reap a lack of satisfaction in your process. Your satisfaction will directly impact the lasting effects of our time and energy (and your money).
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    The following questions are about how you have been feeling during the past four weeks. For each question, please select the one answer that comes the closest to the way you have been feeling, on a scale of 1 to 5:

    1. None of the time 2. A little of the time 3. Some of the time 4. A good bit of the time 5. All of the time
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