Wendy Mendoza, CHPC

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* 1. Your Full Name

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* 2. Phone Number

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* 3. Address

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* 4. City,State

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* 5. Email

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* 6. Occupation

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* 7. Date of Birth

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* 8. Gender

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* 9. Marriage Status

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

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

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

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

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

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

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

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

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

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

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

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* 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?

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

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

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

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