Cutting the Ties Intake Form Name * First Name Last Name Email * Phone * For confirmations and follow-up (###) ### #### T he area of your life where you would like dreams to help you find clarity? * Emotional triggers and limiting beliefs Spiritual gifts Life purpose Health Issues Relationships Other Are you current ly doing any self help work , or working with a therapist ? * Please describe if so What’s the core challenge you’re facing in life ? * What feels stuck, overwhelming, or unclear? What do you think about the most? How would you rate your overall satisfaction with life on a scale of 1 to 10? * With 1 being extremely unsatisfied and 10 being extremely satisfied? What would a meaningful result look like for you 3 – 6 months from now? * What would success look or feel like if things improved? Have you worked with a dream coach before? Yes No On a scale from 1 – 10, how ready are you to invest time, energy, and resources into change right now? * 1 = Just browsing, 10 = I’m ready to go all in Is there anything else you'd like to share to help me make the most of our time together? * Thank you for filling out the intake form. I will be in touch with you via email shortly.
