Wendy Mendoza, CHPC

* 1. Your Full Name

* 2. Phone Number

* 3. Address

* 4. City,State

* 5. Email

* 6. Occupation

* 7. Date of Birth

* 8. Gender

* 9. Marriage Status

* 10. What do you do for a living and why did you choose that career?

* 11. What are the  top 3 goals you are striving to achieve in your life and career right now?

* 12. What major stressors and challenges are you struggling with right now?

* 13. When you feel like you are most successful and happy self, what makes you feel that way?

* 14. What would your dream life look like if you could wave a wand and make it happen?

* 15. What has prevented you from having that dream?

* 16. What goal or dream have you ever given up on or failed at?

* 17. What 3 big changes would you like to make in your life this year and next year?

* 18. What are you most proud of and excited about in your life right now?

* 19. How would your describe your life right now?

* 20. What negative recurring thoughts, fears or behaviors would you like to overcome in order to  feel more psychologically free, confident and successful?

* 21. What distracts you the most from being more productive and what major projects or missions are you struggling to complete faster or more efficiently?

* 22. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

* 23. When do you struggle to be fully present in your day or in any of your relationships?

* 24. How purposeful do you feel in living each day and how would you describe your purpose?

T