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In order for me to get a "virtual fingerprint" of who you
are, please fill out a description of your upbringing and
how you view the world as detailed as possible, below. *
State 3 specific outcomes that MUST happen in your life in
the next 12 months. Pick goals or outcomes that will change
your life in a HUGE way, and they don't have to be
and dream BIG.
What's preventing you and what's the price you'd pay
(energetically, emotionally, financially) to get to where
you want to be? *
Do you believe huge transformational shifts can occur in
your life? (i.e. in your relationships, self-love, belief
systems, income, etc.) *
If age, finances or time wasn't an issue, what would you be
doing with your life? *
In your own words, what do you consider to be your
obstruction (character flaw or biggest saboteur) to personal
and professional growth? Please include any stories you keep
telling yourself as to why you can't be successful.
What do you believe to be your biggest sources of guilt and
Does something or someone in your life prevent you from
doing what you feel called to do? *
It's been my experience that it's not the size of that problem that matters.
It's the size of the urgency or the commitment level that allows people to
make positive and lasting change in their lives. One a scale of 1 - 10, how
would you describe your level of urgency or your commitment to change your
Have you ever worked with a coach/mentor before? If so, what
was your experience? *
This space is an opportunity for you to discuss any other
topics that you feel were not covered in this questionnaire,
that you would like to discuss further with me..
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