Working With Sensei Nancy

Filling out this form is not an obligation for us to work together; this is an opportunity for me to get a snapshot of where you are and the happiness you're looking for.

Please answer the following questions so I can get a feel for your current focus.   All information is strictly confidential and I (Sensei Nancy) am the only person who will read your information. 

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Name *
Email *
Phone Number *
Please tell me Your Story (what brought you to want to my website). Please be as specific as possible and try not to tell me what you think I need to hear but what you REALLY want me to know. *
If were were to schedule a time for us to talk, what do you think would make our conversation valuable to you? *
Where do you feel the most "unheard" or "invisible" in your life? Why do you feel this way?
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How much time do you spend putting yourself first in your week?
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What is your understanding of masculine & feminine energy and how does it apply to you?
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On a scale of 1 – 10 (10 being the highest possible number) how fulfilled are you with your personal life? Please explain in more detail:
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Are you committed to change - what do you feel you want more of in your life? Please explain in more detail:
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If we were to work together, what would make it worthwhile for you?
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How much responsibility do you take for where you are in your life right now?
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What do you count as major successes in your life?
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On a scale of 1-10, how validated do you feel, based on what you have created in your life?
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How likely are you to act when a new idea or concept is revealed to you?
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I'm looking forward to supporting you on this journey. Is there anything else you'd like me to know?
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By checking the "yes" option, you agree to question everything! Something I teach may bring on a completely new meaning for you and you should always trust your intuition! 
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Thank you for taking the time to fill out this information.  

You will receive an email from SenseiNancyMueller@gmail.com within 24 hours

Note:  If there is someone I can thank for referring you to me, please include his or her name below. You can also use this section if there is anything else you'd like me to know or a question you'd like answered.


Namaste,
Sensei Nancy Mueller
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