Name
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First Name
Last Name
Email
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Phone
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Understanding Your Current Situation
What are your biggest challenges right now?
What areas of your life feel out of balance or unfulfilling?
Which of the following best describes your current mindset?
Exploring Your Vision and Goals
What does a fulfilled, empowered life look like for you? (Select the statement that resonates most)
What is your ultimate long-term vision for your life?
Which areas are your top priorities for coaching? (Select up to 3)
Assessing Self-Awareness and Alignment
How well do you feel you understand your own thoughts, emotions, and patterns?
Do you currently have a routine or practice for self-care or personal growth?
Exploring Energy and Alignment
Have you experienced energy healing, meditation, or mindfulness practices? If so, how did it impact you?
Do you feel connected to your intuition or inner guidance?
Commitment and Readiness
On a scale of 1–10, how committed are you to making changes in your life? (Select a number where 1 = Not at all committed and 10 = Fully committed)
What does success look and feel like to you in this coaching process?
What support or tools do you think you need most right now? (Select all that apply)
Additional Information
Is there anything else you would like to share about yourself or your journey so far?
