Goals & Values Realignment Onboarding Form

Name *

First

Last

Email *

Date of birth (DD/MM/YY)

Time of birth (AM/PM)

Place of birth (city+state+country)

How did you hear about Healographic? *

What is one area of your life you would like to work on to bring the most positive change? *

Describe what you want in this specific area. What is your desired outcome? Do you have a big goal that you want to accomplish? *

Let me know about what is holding you back from getting what you want. What are your struggles? What is stopping you? *

Have you ever tried to work on this area of your life before? If yes, describe what you have tried (therapy, coaching, books, personal research etc…) What results (if any) did you get? *

What would you gain if you reached your goal and got what you want? *

What would happen if you didn't reach your goal? *

Are you currently doing therapy, coaching or counselling sessions with another practitioner? *

Have you ever received a mental health diagnosis from a professional? If yes, please list everything here. (This is for your own safety as some of the tools I use - like hypnosis - are not recommended with certain diagnosis) *

Are you comfortable with the idea of exploring past memories that might bring up some difficult feelings? (Don't worry I will be there to hold space for you) *

Do you have any concerns or fears about working with NLP, Hypnosis or being put in a trance state? If you do, write them here and I will answer all the questions you might have. *

Are you ready to take full responsibility for your life and your results? *

Hell yes!

** All of the information provided in this form will remain strictly confidential.