Total Lifestyle Intensive (12 Weeks) – Application

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Develop a Positive Mindset, Achieve Optimal Health, Manage Your Time,
and Make the Most of Your Life With Positive Psychology Principles

 

Application

 
Welcome and congratulations on taking this important step towards creating your best possible self and ideal future! In order to ensure that you will get the most out of this program, please be honest and authentic in your answers. It is important to me that this program is the right fit for you so that you may experience the most benefit!
 

Today's Date:

Name:

Address:

City:

State:

Zip:

Email:

Occupation:

Home Phone:

Office:

Website:

Birthdate:

Spouse/Children/Pets:

 

Please describe your current goals, concerns, desires.

If you could make your life and lifestyle any way you want it in the next 1-3 years, briefly describe that.

What is working well in your life right now?

What isn’t working as well as you would like it to?

What do you value most in your life today?

What do you most hope and want to get out of this program? What are the top 3 goals you would like to have accomplished at the end of our 12 weeks together?

What holds you back from achieving the goals and desires you set for yourself?

On a scale of 1- 10 (10 being the highest), how willing and committed are you to making the changes in your life you would like to make?

Is there anything else you would like me to know?