CLIENT INTAKE FORM Name * First Name Last Name Email * What would you like to accomplish — that looks pretty impossible, right now — but if it was achieved would change everything? * Imagine we meet up 1 year from today, and you are looking back over that year. You say, “Wow! I’ve just had the best year of my life.” Tell me about that… * How could you stop yourself from achieving what you want, in the next year? (We always know, in advance, how we tend to fail at things. Let’s identify that now, so we can handle it). * What would you love to create over the next 5 years? * What’s your Breakthrough Goal? That’s the one thing on your list, that if you focused on it — to the exclusion of everything else — it would be most likely that you’d accomplish everything else, anyway? * What are you willing to sacrifice to achieve your goals? What are you not willing to sacrifice? * What are the biggest obstacles in the way of you getting what you want? * What fascinates you and energizes you? * If someone gave you enough money so you never had to work another day in your life, what would you spend your time doing? * What scares you the most? [Fear is often a mask for desire]. * If you could laugh more and have more fun in your life, what would you do? * What are you tolerating in your life or business? What bores you? * What’s missing from your life or business? And how do you keep it out? * What are you doing that drains you but would energize someone else? * What’s working? What are you confident about? * What’s your Zone of Genius? What are the 1-3 things that fascinate you and energize you the most? * Is there anything else I need to know before we get started? GREAT WORK! LET’S GET YOUR PARTY STARTED!