ATTUNEMENT AGENCY SELF-CARE ACTIVATION Name * First Name Last Name Email * Website http:// How did you hear about us? * Charym Referral Facebook Instagram Other Which of Nicoles's mentorship programs are you most interested in? You may select more than one if you're not sure. * Community Entrepreneurship: Foundations of Business Legacy Attunement: 8 Week Bespoke Self-Care Mentorship Private Somatic Coaching If you already have a wellness practice, how would you describe what you do and how it works for you? What is the (big, bold) goal for your lifestyle? * What do you feel is the biggest obstacle to making your lifestyle, income and time goals? * What is the limiting belief you are carrying in the whole of you that is blocking your success, and are you willing to allow me to help you address that? * I assume that if you haven't yet reached your goals, you are holding at least one limiting belief that is blocking you. Share with us a recent life win -- what are you proud of or inspired by right now? * Would you say, “I trust myself?” * Yes No Finish this sentence: If someone advised me to spend $1000 on my health and enjoyment, I would... * know it's what any serious person needs to do to invest in holistic well-being. be a little intimidated, yet with a proven system I would do it because I'm serious about living well. avoid it at all costs because I want to do things as cheaply as possible. Finish this sentence: Right now I... * have the financial resources to invest in supporting the life I crave. have access to the financial resources to invest in some parts that bother me the most. don't have any financial resources at all & I'm going to keep my lifestyle as is. Finish this sentence: Right now I... * have a minimum of 3 hours per week open so I can learn and implement new energetic practices and/or strategies to improve my lifestyle. do not have any time, but am willing to change my schedule and relationship with time. do not have any extra time, and am unwilling to do things differently to change that. Help me understand how you feel about yourself * I feel great when I wake up in the morning Strongly Disagree Disagree Neutral Agree Strongly Agree I am taking proper care of myself Strongly Disagree Disagree Neutral Agree Strongly Agree I am putting in an effort to cook at home with healthy ingredients Strongly Disagree Disagree Neutral Agree Strongly Agree I have a well-defined set of boundaries in my work and personal lives Strongly Disagree Disagree Neutral Agree Strongly Agree I enjoy my life Strongly Disagree Disagree Neutral Agree Strongly Agree I am exploring my personal creativity every day Strongly Disagree Disagree Neutral Agree Strongly Agree I am able to express myself in a spiritual way when I need to Strongly Disagree Disagree Neutral Agree Strongly Agree I am able to enjoy the pleasurable aspects of life Strongly Disagree Disagree Neutral Agree Strongly Agree My home environment is a place where I can relax and feel satisfied Strongly Disagree Disagree Neutral Agree Strongly Agree I am spending enough time outside Strongly Disagree Disagree Neutral Agree Strongly Agree I accomplished the educational goals I set for myself as a younger person Strongly Disagree Disagree Neutral Agree Strongly Agree I accomplished the career goals I set for myself after school Strongly Disagree Disagree Neutral Agree Strongly Agree We value and respect your time as much as we do our own, so we ask that you make yourself ready and available for Nicole to call you via Facebook Audio at our scheduled time. Do you agree to do so? * (if so, type "Yes, I/we will log onto the Messenger call with Nicole at our scheduled time.") Thank you!
