DIVINITY CODES Program Intake
Before we get started, please take a few moments to answer the following questions that will serve as a guide for our work together. Please be as detailed and as lengthy as you'd like - the more information and background, the better. This will be automatically sent back to you upon completion for your later reference.
Email address *
Preferred Name *
NON-DISCLOSURE OF MATERIALS: Material given to Client in the Program is proprietary, copyrighted and developed specifically by the Mentor, Sydney Campos. Client agrees that such proprietary material is solely for Client’s own personal use. Any disclosure to a third party is strictly prohibited. *
CLIENT RESPONSIBILITY: I accepts and agree that I, the Client, am fully responsible for my progress and results from the Program. The Mentor will help and guide my (The Client) however, participation is the one vital element to the Program’s success that relies solely on Client. The Mentor makes no representations, warranties or guarantees verbally or in writing regarding Client’s performance. Client understands that because of the nature of the program and extent, the results experienced by each client may significantly vary. *
PAYMENTS AND REFUNDS: Client is responsible for full payment of fees for the entire Program, regardless of whether Client completes the Program. If Client is unable to use the sessions for any reason, Client understands that fees are non-refundable. *
DISCLAIMERS: The Client understands that the role of the Sydney Campos, the Mentor, is not to prescribe or assess micro- and macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Mentor is a guide who has trained in holistic health coaching, business strategy, Reiki, Yoga, Meditation and Intuitive Counseling to help clients reach their own goals by helping clients devise and implement positive, sustainable changes. The Client understands that the Mentor is not acting in the capacity of a doctor, licensed dietitian-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Mentor is not meant to take the place of advice by these professionals. *
Briefly describe your experience in transformational work up until this point including any coaching programs, mentors or other personal development work you have done to prepare you for this moment. *
Describe your experience with breathwork, meditation, visualization, energy work, somatic release, yoga and other mind-body-spirit alignment technologies. If you have specific questions Sydney can address at the program outset regarding the nature of somatic experiences we will include in this program, please include them here. *
What is your highest vision for your PURPOSE? *
What is your biggest perceived challenge facing you in embodying your PURPOSE-full high vision? *
What is your highest vision for your POWER? *
What is your biggest perceived challenge facing you in embodying your POWER-full high vision? *
What is your highest vision for your PLEASURE? *
What is your biggest perceived challenge facing you in embodying your PLEASURE-full high vision? *
What is your highest vision for your PROSPERITY? *
What is your biggest perceived challenge facing you in embodying your PROSPERITY-full high vision? *
What do you fear you'll have to let go of in order to truly transform your life (specifically old beliefs and habits, relationships, jobs, etc.)? What have you tried before that hasn't worked?* *
How's your self-care? Do you have a spiritual/energetic practice - what does it entail?* *
What is your relationship status? What is your high vision when it comes to relationships in your life - intimate, family, friends, co-workers? What are you most desiring to shift, create and/or transcend in your relationships? *
What are three (or more if you feel inclined!) breakthroughs you commit to creating within your DIVINITY CODES program? *
How will you know if at the end of the program or sooner (or later) that you've achieved your desired breakthroughs? *
If you could hear (at least) one thing from your future self - in 8 weeks or so upon program completion - what would you MOST want to hear from yourself to support you in your path NOW? *
Lastly, how did you find out about DIVINITY CODES? What made you say YES to this divine opportunity to transcend all that's in your way of embodying your divinity? *
A copy of your responses will be emailed to the address you provided.
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