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Authentic Wildness™ Personal Guidance Free Consultation Questionnaire

Thank you for your interest in working with me! Please take a moment to complete this form. It will make our session more efficient. I look forward to our time together!

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Question 1 of 12

Phone Number

Question 2 of 12

State and City of Residence

Question 3 of 12

 

What is your intention for receiving my guidance?

Question 4 of 12

What is your number one pressing problem or concern right now that you would like help with?

Question 5 of 12

What are the three biggest obstacles preventing you from having what you want in your life?

Question 6 of 12

 

Are you currently taking any medications for mental health issues?

A

Yes

B

No

Question 7 of 12

 

Do you have any drug or alcohol related addictions?

A

Yes

B

No

Question 8 of 12

Have you ever received personal guidance, coaching or therapy?

 

If yes, have you worked with a life coach, spiritual guide, psychologist, psychiatrist, and/or therapist?

 

When and length of time which each.

 

What was your personal experience with each type of support?

Question 9 of 12

 

How would you describe your personality?

Question 10 of 12

 

Why are you drawn to me for guidance?

Question 11 of 12

 

Are you willing to invest in receiving support and guidance right now?

Question 12 of 12

 

How did you find me?

Confirm and Submit