The Mind Body Initiative Application

The Mind-Body Initiative Application

Please fill this out before your call

First Name

Last Name

Phone Number

Address (street, city, state, country, zip code)

Occupation

Please list & describe your current challenges or areas of resistance in your business? In your life/relationships? (think physical, mental, emotional, energetic)

What percentage of the time do you experience these symptoms?

Please list all diagnoses

What areas of your life & business do you desire the most support with?

How "in control" do you feel over your current experince?

How would you describe your current physical health?

How would you describe your emotional health?

How ready are you to start making changes in your life?

Have you ever worked with a coach or mentor to support you in your business growth & nervous system healing?

How did you find/hear about the Mind|Body Initiative?

Why do you want to join the Mind|Body Initiative, and what do you hope to gain from the program?

The Mind-Body Initiative Application

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