Assessment Page

First Name *

Last Name *

Email *

Phone *

Address *

City *

State *

Postal code *

What does you life look like right now? *

What would your ideal life look like for you? *

What is holding back from achieving this? *

Looking at the three you picked above which one do you feel you need to work on the most? *

What emotions that are not serving you tend to surface? *

Which one of the fears below have you felt the most as you grew up and what was the circumstances around that? *

If you look at the emotions that come up, want is the earliest memory that you started to recognize were the emotions were the byproduct of this event? *

When looking at the event, did you gain any strength from this event? *

What was your relationship with mom growing up? *

What was your relationship with dad growing up? *

What do you feel is the most traumatic event that has happened to you ? *

What are some of the limiting beliefs or habits that have been developed that is holding you back? *

Looking at what you just talked about what would it mean for you to have this issues cleared up for you now? *