The Key to Your Future Lies Within!

Intake Form

CLAIM IT!  Yes, I'm ready to claim my FREE "Step into my DREAM" Discovery Consultation!  

Please fill out the Dream Curriculum Intake Form and submit to us prior to scheduling, so that I may begin to familiarize myself with your unique needs.  The form is absolutely confidential, so feel free to be as honest as you need to be.

What are the main issues in your life right now that you need help with?

What issues have you had in the past that you feel have a bearing on your situation right now?

What steps have you taken in the past to address your issues and how well did they seem to work for you?

Do you have any support right now for the problems that you are facing?

Are you dealing with any past traumatic events and/or addictions?

Are you dealing with any serious, chronic health problems?

How easy do you feel it is to express your deepest needs?  Are you able to ask for what you want?

How successful in life do you feel yourself to be?

What is the highest level of education you have completed?  In which field or fields?

What is your greatest accomplishment?

What would you like to get out of our time together?

Describe honestly what you were feeling as you were filling out this form: