NEW CLIENT QUESTIONNAIRE New Client Questionnaire First and Last Name * Phone * Email * What are you desiring to get out of your time with Kerin? * Why have you not been able to achieve this in the past? * What does your dream life look like? * Body, relationships, love, work, etc. What would be your best guess as to why you have not been able to achieve the things you desire most? What do you believe is standing in your way? * On a scale from 1-10 how would you rate how YOU are showing up in each of these areas: Health * 1 2 3 4 5 6 7 8 9 10 Finances * 1 2 3 4 5 6 7 8 9 10 Family * 1 2 3 4 5 6 7 8 9 10 Relationships * 1 2 3 4 5 6 7 8 9 10 Joy / Adventure * 1 2 3 4 5 6 7 8 9 10 Spirituality * 1 2 3 4 5 6 7 8 9 10 Career * 1 2 3 4 5 6 7 8 9 10 If you were to achieve exactly what you want tomorrow, what is the fear(s) that comes along with it? * Think deep with this one. What are the beliefs that your father, mother, or society told you? If you were to achieve exactly what you want tomorrow, what pattern would you need to break or change in order to call in your desires and/or KEEP your desires (i.e. be able to maintain)? * For example, many people want a great body, but don't want to exercise. They want great love, but aren't willing to accommodate. They want more money, but aren't willing to get vulnerable. What do you love about yourself? List out 50 things. (Physical traits, personal strengths, what you are good at, personality traits, etc.) * TIP: This should be an even list between your internal features (who you are) and your external features (what you look like). It's about loving everything about yourself. Submit
