Please answer the questions at least 24 hours before our scheduled appointment. I look forward to speaking with you soon!
Sign in to Google to save your progress. Learn more
Email *
Your name
Your phone number
1. What interested you in having a consultation?
2. What is the main area of struggle or concern in your life right now?
3. Describe your ideal life. If you could resolve your main area of struggle and live a life you LOVE, what would that look like?
4. What self-improvement work (i.e. books, courses, coaching, etc.), if any, have you done previously and what has been your experience with it?
5. On a scale from 1-10, how ready are you to invest in changing your results in your main area of struggle, on a mental, physical, and emotional level?
Clear selection
6. Up until now, what has kept you, from experiencing optimal results? What do you think is the underlying, REAL reason?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy