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* 1. *Please note that all of the information you provide is fully confidential and will never be shared.  

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* 2. Who referred you to Heidi?

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* 3. What is your name?

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* 4. How can we reach you to set up your consultation? (best email & cell #)

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* 5. What inspired you to request a consult with Heidi?  What challenges are you facing?

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* 6. If you could wave a magic wand, what changes would you make in your life right now?

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* 7. In what ways have you previously tried to address these challenges? What were the results?

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* 8. Do you feel that you are ready and willing to address these challenges, invest in yourself (emotionally, time-wise and financially) to create the change you're desiring ?

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* 9. On a scale of 1-10  ("10" being most important), how important is it for you to break free from these challenges and create inner peace, freedom and authentic happiness?

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* 10. Thank you for taking the time to fill out this application.  Please feel free to share below anything else you'd like Heidi to know:

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