Engagement Questionnaire
IT'S TIME TO SHINE YOUR LIGHT! Your commitment & desire to achieve greatness begins with a decision, saying YES.

Thank you for your interest in a new Lifestyle for YOU. Please help me understand you better. We must begin with a starting place so we can move into the flow you desire to create in your life.

First Name
If your first name is different than what you wish to be called, please advise of both names.
Your answer
Last Name
Your answer
Phone Number
Text number preferred as well as Skype Name. You may also provide other contact numbers that will be helpful for Melissa
Your answer
What is the general nature of your desire to work with Melissa?
What's going on? Be REAL, open and please be honest. The more you can share the more Melissa can help.
Your answer
What is your ultimate 90 day goal & what kind of life do you DREAM of living?
What is your desired outcome? If Melissa had a magic wand and granted your wishes, what would they be? If you are working with her for 6 weeks, please state your goals and desires in 6 weeks what you desire to accomplish. Remember to be clear and specific. The Universe helps guide us when we are specific.
Your answer
Help Melissa understand HOW SHE CAN BEST serve you in achieving your goals? And why she should work with you?
Explain 3 things you would like to focus on in the Session or Program
Your answer
What have you tried and HASN'T worked for you?
What is holding you back? What is the reason you aren't having the success that you desire?
Your answer
What area of life do you find most challenging? (Health, Wealth, Happiness, Relationships, Family, Business)
What is it you want to have MORE of in your life? (answer AFTER the 1st question about the most challenging)
Your answer
How would you like to be supported?
What sort of guidance, support or coaching would you like to receive? What works best for you? Are you visual, kinesthetic or auditory? Please share a time in your life where you felt ULTIMATE support and confident in what you were doing.
Your answer
What are you NOT willing to do to achieve your goals?
Be honest. Melissa needs to know.
Your answer
Melissa is a natural born fire starter, she ignites the flame in you. Often times, she requests you to do things outside of your comfort zone so that you can grow into your flow. Are you willing to do this and participate? (Of course she's not going to ask you to strip naked and run down the street of course
Any other helpful information you would like to share with Melissa.
How can you be best supported? Do you need a framework to build from? Do you need to visit belief systems within yourself? Do you require an accountability partner? What is it you REALLY need?
Your answer
Look. At the end of the day I can show you tips, tricks, techniques and the mechanics of how to get things done and experience the results you want, the underlying difference is you TAKE ACTION and implement what you learn. Otherwise, it will remain another statistic.
Question is are you willing to take action?
Have you ever invested in personal development and lifestyle coaching?
I look forward to serving you so you can serve the masses and be the LEADER you are called to be.
How much are you willing to invest in your Self to create a plan and put into action this plan?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms