Application for a free "Deep Sleep Clarity Session" with Stella Scott
A warm welcome to you!

I know you are here to get clear on and understand your sleep problem and finally get a grip on how to make it disappear.

As you already know, I help women with sleep problems and stress, who drag themselves through life while feeling too tired with no energy. My guess is you haven't encountered the right mentoring before and therefore feel kind of hopeless and helpless.

If you have those problems and feel uncertain of which road to take from here then fill out this questionnaire. It's an application for my 1 on 1 program "The Sleep Puzzle", where we do a personalized deep dive into your challenges with sleep and stress to energy and joy of living.

Please answer the following questions as honestly as you know how at this moment.

They will be a first evaluation to see if a conversation could bring you further with my help. If so these questions will serve as a roadmap for our future conversation and hopefully, the successful resolution to your suffering!

If I don't think I'm the right person to assist you at this point, I will tell you and hopefully I can point you in other, more fruitful directions.

Email address *
Full name *
Your answer
Your full address (with Zip code and country) *
Your answer
Primary E-mail *
Your answer
Mobile Phone number (with country code) *
Your answer
Skype, if you have
Your answer
Date of Birth *
Occupation? Happy in this position? *
Your answer
Relationship status? Happy or could be better? *
Your answer
Children? (How many and age) *
Your answer
How does your lack of sleep affect your everyday life? *
Your answer
For how long have you had problems with sleep? *
Your answer
Do you take any medication for sleep, depression or other? *
Your answer
Are you stressed about anything specific or in general? *
Your answer
Did you ever sleep well before? *
Your answer
How many sleep problems do you have? Check any that apply *
From the answers above, which three (3) are most disturbing? *
Your answer
What kind of help have you previously tried? List any- and everything from acupuncture, and healing to herbal teas and prescription pills. *
Your answer
What were the results? *
Your answer
How satisfied are you with the help you got (1 not at all, 5 very much so) *
Anything else you want to tell me about your sleep? *
Your answer
What are you missing, loosing out on that others seem to have? Or that you had before, if you've slept well previously in your life? *
Your answer
How will your life change for the better when you regain a healthy sleep pattern? *
Your answer
The Work!
This section is about your willingness to invest in yourself
On a scale from 1-10 how important is it for you to get good sleep right now! *
I can wait
I'm desperate!
How ready are you to go with unconventional methods and work them through? *
Preferably I want things to be tested and proven before I do anything
I'll try whatever att this point!
If you discover you'll have to make a big shift in your life situation to be able to reach peaceful sleep, are you willing to take those measures? *
How much time, money and courage would you be willing to invest for a permanent solution to your challenges with sleep? *
A little
I have recourses
I'm giving it my all!
What is your biggest worry or fear if you don't resolve your sleep issue ASAP? *
Your answer
What would be the best thing for you to take away from our coming session? *
Your answer
How did you hear about me? *
Your answer
Thank you!
I much appreciate you immersing yourself into this process as questions do bring things to the surface.
I'll be back with you soon with my first evaluation. If we seem like a good fit we'll schedule a date then for a deep dive conversation.
If you have questions before our session write to me at
Very last thing: A reminder to cancel no later than 24 hours before scheduled time. I bill all no shows with my regular fee $247.
A copy of your responses will be emailed to the address you provided.
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