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* 1. Name (optional)

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* 2. Age?

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* 3. What are you struggling with when it comes to feeling completely happy and self-confident? What are the current fears, doubts and insecurities you are dealing with?

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* 4. Do you feel like your life has been hijacked and what do you feel has been taken away?


 

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* 5. What have you tried in the past to make changes to bring you closer to reconnecting with who you are and getting the most out of your life?  (Coaching, classes, seminars, self-help books, etc.) I would love to hear about your experiences - were they helpful / not helpful and why?  



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* 6. Is there anything in your life that feels heavy and is stopping you from getting you where you want to be?? What would you do if that blockage was removed?



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* 7. What would give you the permission you need to really get out there and reclaim yourself and your life and why?



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* 8. What are you just dying to learn or know about how to reconnect with who you are and how to get your life back on track? If someone could swoop in and help, what would you want answers too?



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* 9. What fears do you have about working on asking for what you want, being who you are, standing up and being confident in yourself?  Does anything about the process of getting there, or the final results scare you?

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* 10. If it’s ok for me to follow up with you about your answers, please leave me you email address.



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