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.
Email address *
Name, First and last *
Your answer
Phone Number *
Your answer
I am interested in working with Jacqui through: *
The three biggest changes I'm looking for in my life are: (examples, weight loss, physical strength, stress reduction, resilience, etc.) *
Your answer
What are you aware of that keeps you from achieving the changes you want to see? *
Your answer
What is most at risk if things don't change? *
Your answer
What are 3 words that describe your current state? *
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. *
1
10
What times work best for you for a 20-40 minute call *
A copy of your responses will be emailed to the address you provided.
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