Intake Form: ( Please copy/ paste and fill up empty spaces in your document with your info and return back to me on my email (livingharmony2013@gmail.com). It will served us as a base line for our AMAZING work together. 100% Confidentiality Guaranteed!


Your LIFE flashback, please….Write me ‘WHO YOU ARE’  in a simple format, share with me your life highlights only — as much as you feel like sharing, max. 1 page

Please answer  ALL questions:

  1. What is it that you are most determined to change in the next six months? (Business/career, finances, health, relationships)
  1. What are you doing right now to make things different in this area?
  1. What are your 3 biggest challenges to this?
  1. What’s the #1 obstacle keeping you from solving these challenges?
  1. On a scale of 1-10 with 10 being critical, how important is it to you to get these solved and why?

Full Name (Real One please, your nick name might be shared later….):

Date of Birth:

Your job/ education /training :

Hobby/ Interests/ Likes to do:

Primary Email Address:

Any significant sicknesses or other health / life conditions, I should be aware of…(please do not ignore this part, thanks)

Phone number or/Skype:

Time zone

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