Voice of Truth Work In-take Form
A short form to ensure energy alignment with this body of work
Email *
Name *
What time and day are usually best for 90 min session?
Phone # 
Please tell us more about your background with any "Inner Truth" Work, Emotional Processing, Communication , Connection skills (NVC, Authentic Relating) and any soul, spiritual or mindfulness practices you have done or currently practicing.   Don't worry if you have none, that does not preclude you.. :) 
Rate Your Quality of Life Overall *
Very Poor and/or struggling alot
Amazing, never better
Rate Your Most Consistent Emotional State (and if on roller coaster of emotions with lots of ups and downs then would be lower on the scale v. a 5 in the middle).
Very unstable all the time
Stable and Strong all the time
Clear selection
Rate the Quality of your physical health
Very poor.
Its great.
Clear selection
Rate the Quality of Your Diet
Really poor. Sugar, junk food all the time
Could not be better, eating clean, unprocessed foods all the time
Clear selection
How do you express your sexual energy more than not lately (don't worry this form is private). 
Clear selection
Rate the Quality of Your Information Consumption (ex: News)
Reading/Watching Negative News & Shows or Social Media many times. aday
Rarely engage in mainstream negative news or social media
Clear selection
Rate the Quality of Your Community Connection
No community to speak of
vibrant community I engage with all the time
Clear selection
Rate the Quality of Your intimate relationships (Partner, spouse, significant other,,). If not in one, mark down as a 5
not good, very destructive
Really thriving
Clear selection
Rate the Quality of Your Connection with Friends
Really poor to non-existent
Very Connected on deep, supportive level
Clear selection
City, State, Country *
Check 1 - 3 Boxes that align with why you are interested 
Which one of the Above Choices would you consider the top or #1, #2 and #3  reason and why? 
How Best Would You Describe Your Most Consistent State in Life right now? *
What would best describe your most consistent state of energy or mental health?
Clear selection
What is your biggest career challenge, if any? *
Describe What Life is Like at Home (1 - 3 sentences)
Describe Where You feel Most Stuck in Life or Biggest Challenge /Obstacle (1 - 3 sentences)
What is Your Familiarity with Circles, Council or small group work? *
What identity do you most resonate with?
Clear selection
In your own words, What would you like to see happen as a result of your participation in this program?
What time are best for you to do our gatherings ? (ex: weekends; after work hours; mornings;  monday mornings...).  be sure to add your time zone
Any challenges financially we can help you with (ex: does a $250 deposit to hold time/space for you to do work cause distress?
Clear selection
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