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Systems Therapy Intake Questionnaire

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Hey there, purpose-focused human!!

If you're managing leadership, meaningful work, family, and creative pursuits—all while fighting systems designed for machines—you're in the right place.

This questionnaire is the first step toward your personal systems guide. It takes 20-25 minutes and helps me understand what's not working in your current systems, what you've already tried, and what your actual life looks like.

After you complete this, we'll schedule a working session to dig deeper. Within one week after that session, you'll receive a ready-to-implement guide designed to address the one thing that's costing you the most.

Calls are 60 minutes long, and are recorded for my reference as I build your guide. Everything you share is confidential.


What to Expect

This form has four key sections where you share more about your current systems. You'll then review the Terms & Conditions for R21.5 x MjR. Once you agree and submit, you'll be redirected to Gumroad to complete payment. After that, you'll receive a link to book your session.

Sections

1. Biographical Info
2. Personal Workflows
3. Personal Challenges
4. Personal Support
5. Terms & Conditions

Next Steps

6. Payment (external)
7. Session Booking (external)

Sound good? Then click that Next button, and let's go!