Aligning for Transformation- Simple Mapping
Hello!

Thank you for choosing to align and transform. By aligning your goals, needs, and passions and working through internal blockers you can transform your life beyond your wildest dreams. Are you ready?

Please take some time to complete this form. Try not to over think it. The form is a great way to give us a head start at working together and it saves you time in a session with me.

It is not in any way mandatory, nor does it provide any standardized profiling information. This is a simple template with common discussion items that can help us pinpoint what we might want to work on, also known as trailheads. There is also an open question for any comments or questions you think might better serve your particular needs. This and everything we discuss will remain confidential.

I look forward to the opportunity to help you launch yourself into your personal success!

Best,
Theresa
Email address *
Name
Phone - *remains confidential*
Best way to be reached- * no spamming*
Gender
Age
I would like to work on:
What is my biggest obstacle?
How happy would I rate myself as being in this moment that I am taking action.
Usually when I set my mind on something...
I consider myself to be an
Choose sentences you most agree with;
Being as healthy as I can be is a priority.
Do you have unused memberships to health facilities/classes/apps?
Do you prefer to exercise with friends, strangers, or solo?
I consider healthy eating a priority.
Think about the last week of meals. Do you typically eat out (count anything you do not cook)
What is your current fitness PRACTICE. How often do you engage in any form of exercise?
My favorite physical activities are:
What are your health goals?
What has been your biggest barrier to self care?
Are you at your ideal weight? Is this a goal?
When were you most satisfied with yourself / your life?
If I could choose anything and everything to make my life perfect I would pick...
My greatest fear is that...
If I were to become my friend, qualities I would appreciate most would be...
When it comes to self sabotage I usually...
If I could be someone famous I would pick... because...
If I were my parent I would say that the child version of me is...
One thing I regret most in my life is...
The greatest thing I want to change in my life right now is...
I prefer to work with a coach
I understand this is a coaching service that is not a replacement for therapy or medical treatment. I also understand that although results can be extraordinary and fast, they differ from person to person. If at any time I decide to stop, I can get a refund for unused prepaid sessions. If my coach feels this is not a good match, she will issue a refund for unused prepaid sessions. Please sign full name below.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy