Your full name and the name you choose to be called: ____________________________________________
Email address: ________________________________
Date and place of birth:_________________________
Referred by (how you heard about me):____________
Do you have children and how old are they ? _______
Your current occupation: _______________________
Do you have an history of alcoholism or drug abuse, or are you influenced by this with spouse or family members: ___________________________________
A bit about your relationship history that you wish to share: ______________________________________
Your goals, outcomes and intentions in regards to this “ EMPOWERING WOMEN INSPIRATIONAL BOUNDARY MASTERY PROGRAM “ : ________________________
In what ways do you feel powerful ? ____________
In what ways do you want to feel more powerful?
WHEN YOU CHANGE THE WAY YOU LOOK AT THINGS…THE THINGS YOU LOOK AT CHANGE !
DR. WAYNE DYER
On a scale of 1-10 … with 10 being the highest, how would you rate your:
1. Sense of self:
2. Satisfaction with your home life:
3. Satisfaction with your social life:
4. Satisfaction with your personal/relationship life:
5. Satisfaction with your career/employment:
6. Financial situation:
9. Creativity in your life:
10. Personal joy:
12. Love that you receive:
13. Love that you give:
14. Self esteem:
18. Obtained accomplishments:
19. Goal settings:
20. Optimism for achieving goals:
21. Physical appearance:
23. Emotional stability:
24. Spiritual fulfillment:
25. What do you think your life purpose is______________________________
26. Do you read and what kind of books do you read______________________________
If you could name one thing that has been stopping you , or holding you back from moving forward during the past year ( or several years ), what would it be ?
What have you liked most about your life in the past 5 years?
What has been the most difficult for you in the last 5 years ?
Name several things you particularly like to do:
Name several things you do not particularly like to do:
Inspired thoughts you would like to share?
If you could change anything about your future, as it appears to you now, what would it be ?
What goals are you ready to initiate, or follow through with, at this time ?
What, if anything, do you do to reconnect with yourself ?
Do you meditate ? If yes, how often ?
What ways do you connect with nature ?
List examples of how you like to express yourself creatively ? (e.i., art, dance, music, writing, etc.)
Describe some of your favourite things to do to relax, play looking after your inner child.
What activity(s) do you enjoy doing that make you unaware of time passing ?
What makes your heart sing ?
What do you consider to be your best strengths ?
What is the most important thing that you learned this past year ?
If you were not doing what you are doing now, what would you like to be doing ?
What characteristics or traits do you find most appealing in others ?
What have you been procrastinating about lately ?
What is it that you think you had as a child that you do not have now ?
What talents do you have that few, if anyone, see ?
If you were guaranteed success, what would you do ?
THE FASTEST WAY TO YOUR END GOAL IS IN A STRAIGHT LINE OF THOUGHT…FOCUS IS MAGICAL !
“ YOUR STRENGTH INSPIRES ME “ ! THANK YOU FOR FINISHING THIS DOCUMENT AND SENDING IT BACK TO ME SO THAT I CAN INTERACT WITH YOU WITH LOVE , COMPASSION AND UNDERSTANDING !
EMPOWERING WOMEN INSPIRATIONAL BOUNDARY MASTERY
Wishing you inner peace, love and many blessings,
Email : firstname.lastname@example.org
Skype : katharinebeautifulday101
Facebook: Katharine Everest / Katharine’s Sessions
I offer through “Katharine’s Sessions” : Empowering People Inspirational Boundary Mastery Program and Soul Light Art and Writing Circles .
Books on the horizon by Katharine Nightingale in late 2017 , Colour Your Wings … This Is My Wish For You…A Children’s Book Of Love , Gluten Free Comfort Food…For Your Love Of Life and Good Morning Beautiful Loving Stories In Praise Of Pet Parent’s Everywhere , for children . Available on all worldwide platforms in ebook and paperback in late 2017 .