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Coaching for Liberation Confidential Prospective Client Questionnaire—The Esoterick Liberation LLC

This is the confidential prospective client questionnaire for Coaching for Liberation services. If you have received forms for Reiki, STOP! Please contact [email protected] for the correct form.

Please fill out this form before your Discovery Call. This helps me get to know you, and begins the process of discovering what you want to get out of Coaching for Liberation!

Client Record Name

Your Client Record Name is often referred to informally as your “legal name;” but this is incorrect. There are names that require legal documentation to change from one name to another, such as your driver licence or passport. However, one’s name is not considered "legal" or "not legal," according to our policy. For your Client Record Name, please enter your name as it appears on government issued identification.

Preferred Name

Pronouns

Email Address

Street Address (including unit)

City

State or Province

Postal Code

Country

Phone

Occupation

Tell me a bit more about yourself.

Why are you seeking Coaching for Liberation?

Where are you today? How did you get here?

What do you want to change? What do you want to achieve? What kind of future do you want to design?