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Let's see if we are a good fit!
Fill out this brief questionnaire to be considered to work with me :)
Write your full name
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What is your email address?
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What made you want to book a consultation call with me today?
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What is the biggest challenge you are facing right now?
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If we could solve 1 problem during our session, what would you want it to be?
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What is the area you need help with? (Check all that apply)
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What is the area you need help with? (Check all that apply)
Describe what a typical weekday looks like for you?
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What have you already tried that hasn't worked?
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What obstacles keep getting in the way?
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What would success look like 90 days from now?
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On a scale of 1-10, how committed are you to making changes?
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On a scale of 1-10, how committed are you to making changes?
A
1-2; not committed
B
3-4; slightly interested in committment
C
5-6; I'm halfway there, but unsure
D
7-8; I'm very optimistic about change and committed
E
9-10; absolutely committed
How many hours per week can you dedicate to implementing new systems?
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How many hours per week can you dedicate to implementing new systems?
A
None
B
1-2 hours
C
3-4 hours
What are you hoping to walk away with from our session?
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Fit confirmation
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Fit confirmation
I understand this is educational consulting and coaching, not therapy, not legal advice, and not medical treatment.
I understand results depend on my own implementation.
I agree to the cancellation and refund policy.
I understand that Cynthia will reach out to me via a zoom link after she reviews this questionnaire if it is a good match.
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Signature
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