Personal Growth Questionnaire

Let's see how we'll be working together!

Welcome! Thank you so much for your interest in working with me. I appreciate you taking the time to answer these questions with transparency and accuracy so we can move closer to helping you develop the best strategy. Please know that you are not required to answer any question(s) beyond your comfort level, while also understanding that if certain details are not provided, I may not be able to offer you the full scope of my services. If your needs exceed my services, I'll be happy to recommend a referral.

Disclaimer: My services are part of the healing arts and/or professional development. I am not a licensed therapist or medical professional, and I do not address questions regarding health or legal matters. I may refer you to someone else or another service, depending on your needs. By participating in my services, you understand that Tarot and Astrology are for entertainment purposes only and are not meant to supplant medical, legal, professional or business advice. You also agree that whatever feedback is shared during our session, that you are responsible for your choices on any decisions or actions that might be inspired by the reading(s).

Privacy: Your answers are kept confidential and I never share your information with anyone. If I suggest a referral, I'll be providing you with referral information, not sharing your information with anyone else.

Age requirement: I read and provide services for individuals 18 years of age or older.

By completing this questionnaire and booking a service, you agree to these terms.

Let's get started!

Question Title

* 1. What are your short term goals? Check all that apply.

Wellbeing

Life balance

Relationship(s)

Creativity

Career

Place of residence

Confidence

Other (please specify)

Question Title

* 2. How would you describe your current situation? These questions are crucial to answer because your safety and well-being is of utmost importance. These questions help assess risk and whether my services are right for you or if you'd be better served by someone with different skill sets. I want you to receive the best attention possible.

I'm in a great place.

I'm feeling stable - no serious ups or downs currently.

Unstable - Life is extremely challenging though I'm not in an emergency situation.

Crisis - My situation constitutes as a crisis and could be considered an emergency.

I am currently experiencing suicidal thoughts (if this is the case, please call 911 immediately)

I am worried that I may hurt myself or someone else (if this is the case, please call 911 immediately)

Life threatening emergency (if this is the case, please call 911 immediately)

Please feel free to elaborate on your current set of circumstances. You may also include any topic(s) that you'd rather not talk about during the session.

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* 3. Are you currently or have you been in therapy to address the issue you're writing to me about now? (your answers are never shared).

I am currently in therapy

I used to be in therapy

I am not nor plan to be in therapy

I would like to seek therapy but have not yet

Please feel free to elaborate the state of your mental and emotional health

Question Title

* 4. What services are you most interested in? (check all that apply)

Tarot card reading

Astrology reading (please enter date, time and location of birth in the text section below. If you don't know, mention that)

Reiki

Meditation

Sound healing

Coaching

Fitness

Yoga

Writing

Online classes and workshops

In person classes and workshops

Overall wellness

Natural remedies

Crystal healing

Please specify how you would like to benefit from my services (i.e. if you have a Tarot question, please list it; if you would like coaching, please specify what kind of coaching; if you would like an Astrology reading, list date/time/location of birth if you know it, etc.)

Question Title

* 5. How would you describe your personal style when it comes to learning new things or being receptive to information and feedback?

Organized

Spontaneous

Creative

Sensitive

Intellectual

Emotional

If you would like me to be additionally aware of ways of learning that work best for you, you are invited to elaborate. Feel free to share any challenges and/or strengths you'd like me to be aware of.

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* 6. Please list your contact information and when you would like to get started (your information is never shared).

Name (preferred pronouns welcome--mine are she/her)

Phone

How do you prefer to be contacted to confirm next steps? (phone, email?)

When do you want to get started? (i.e. as soon as possible, in the next few days, in the next week or so, in the next month or so)

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* 7. Have you ever received the kind of service(s) you're looking to receive now?

Yes

Other (please specify)

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* 8. If you answered "Yes" above, please describe your experience receiving the service.

I found it helpful

I didn't find it helpful but want to try again

Other (please specify)

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* 9. Please sign me up to receive your e-newsletter about your full spectrum of services including special offers, workshops and events (your information is never shared and I'll never spam you).

Yes, please

No, thank you

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* 10. How did you learn about my services?

Instagram

Facebook

Urban Siren Podcast

Website

Google Search

YouTube

Word of mouth

Personal referral

Other (please specify)