VIP Self Growth Client Questionnaire

I want to acknowledge you for your desire for Self Growth. Many people are not willing to take the time to venture into uncharted inner territories to make new discoveries about who they are and what really matters to them in life. I can assure you that one regret you will never have is the energy you have put into your own Self Growth.

These questions are designed to gain a fuller picture of you. Give yourself the time and space to access your answers. Think in terms of what you want to do and/or have in the different areas of your life in the next 6 months, year or beyond. Your answers are 100% confidential and will be sent directly to my private inbox. I look forward to speaking with you soon.

Your Name:

Phone:
HomeCellBusiness

Email:

Can you be contacted here?

Street Address:

City:

State:

Zip:

Country:

What do you do for work, or how do you spend your time in ways that are purposeful and meaningful to you?

Your birthdate?

Marital Status: SingleMarriedDivorcedOther

Spouse's Name:

If divorced, since when?

How would you describe your relationship with your significant other and/or ex?

Children names and ages:

How would you describe your relationship with your children?

What do you want to ( or know you need to) change, fix or improve in the next six months to a year? ( You may want to come back to this after completing the next eight questions. )

What would you like to change or improve about your Physical Health?
(ie. vitality, symptoms, energy, pain, general physical well-being, etc.)

What would you like to change or improve about your Mental Well-being?
(ie. clarity, concentration, focus,‘brain noise’, intellect, thinking, knowledge etc.)

What would you like to change or improve about your Business or Professional life?
(ie. sense of purpose, vision, growth, opportunity, success, direction, fulfillment, etc.)

What would you like to change or improve about your Relationship or Love Life ?
(ie. communication, affection, agreements, sex, connection, support, fun, etc.)

What would you like to change or improve about your Financial Life?
(ie. income, investments, net worth, philanthropic endeavors etc.)

What would you like to change or improve with your Family Life (children, siblings, parents)?
(ie. unresolved issues, current challenging communication, repeated difficult patterns, etc.)

What would you like to change or improve about your Spiritual Life?
(ie. beliefs, wisdom, understanding, faith, direction, sense of connection, inspiration etc.)

What would you like to change or improve about your Relationship with Yourself?
(ie, self-appreciation, self-confidence, self-care, life purpose, etc.)

What are the top 3-5 accomplishments in your life you are the most proud of?

What are the top 3-5 activities you spend most of your time in on a weekly basis?

What are the top 3-5 things you want to manifest, create or bring to life in the next year? Why is this important to you?