Clarity Session Application
All responses are completely confidential. When you are selected for clarity session, you will receive an email, detailing what to expect, and confirming a time and date for your appointment.
* Required
Email address
*
Your email
Name, First and last
*
Your answer
Phone Number
*
Your answer
I am interested in working with Jacqui through:
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Private pilates/ yoga
Group fitness classes at Pure Body Bliss
Health and Lifestyle coaching
Meditation/ spirituality
All of the above
The three biggest changes I'm looking for in my life are: (examples, weight loss, physical strength, stress reduction, resilience, etc.)
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Your answer
What are you aware of that keeps you from achieving the changes you want to see?
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Your answer
What is most at risk if things don't change?
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Your answer
What are 3 words that describe your current state?
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Your answer
On a scale of 1-10, (10 being completely committed) how committed are you to making the changes necessary to get what you want.
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1
1
2
3
4
5
6
7
8
9
10
10
What times work best for you for a 20-40 minute call
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Mornings
Mid-day
Evenings after 5 pm
Weekends
A copy of your responses will be emailed to the address you provided.
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