Clarity Call Questionnaire – Intake Form – Getting to Know You
Please answer all the questions below. All information is strictly confidential. This helps you define and clarify in your own mind exactly where you are now and what you want to accomplish in your sessions. Please send completed from to me prior to our first call.
PDF Version to Download and Print: Clarity Questionnaire
CONTACT INFO
Today’s Date:
Your Name:
Phone:
Email:
Best time to reach you:
Preferred method of contact: (email, text, telephone, etc.)
GOALS
Is it alright with your unconscious mind (the deepest most inner part of you) to make positive changes in you life during our sessions together and for you to be aware of these changes consciously?
What is the biggest problem, concern or issue you are struggling with right now?
What are the top three things/situations that stress you most?
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Do you have any fears or phobias? List, if any.
List three specific goals you want to achieve in the next three to six months.
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What is the one biggest goal you want to achieve in the next 12 months?
If we were working together for twelve months, what would have needed to happen in the past twelve months for you to be happy?
Is there anything else you want to share before our first call?
Send Form to:
Email: support@danielsweetnlp.com