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Fearlessly Embodied Mastermind Intake Form

I am beyond excited and proud of you for taking the leap to investment in yourself and are joining us inside Fearlessly Embodied Mastermind. You made the decision to get out of your own way and really step into the woman you came here to be!

Your soul decided it was finally time to come home to the woman you know you are and step into your new reality that is waiting for you! I am so proud of you for believing in yourself and welcoming in more self love, abundance and true joy.

Important: Please set aside approximately 30 minutes to complete this form. Upon completion you will be take to register your Mastermind Account on our membership portal. Note: You cannot access the portal until this is submitted.

Name *

First

Last

Email *

Phone *

Instagram

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What called you to enroll in Fearlessly Embodied? *

What are the specific goals would you like to focus on during our time together? *

Mindset & History

What was your family life and childhood like? *

How would you describe your relationship with your mom? *

How would you describe your relationship with your dad? *

Do you have siblings? Explain the dynamics and relationships. *

How do you feel this has shaped you into who you are today? *

What are 3 limiting beliefs about your life?  *

How can you turn those 3 limiting beliefs into empowering beliefs?  *

What is your story around your life?  *

Where do you feel stuck in your life?   *

What is most comfortable about where you are now?   *

How is your current situation not meeting your value requirements?  *

What would you like to improve about your mindset?   *

Do you believe in a power higher than you? *

What are childhood experiences that you are afraid to look towards. *

Money Mindset

How is your relationship to money? *

What is your money story?   *

How do you feel around receiving money?  *

What childhood stories can you think of that remind you of money?  *

What was the dialogue around money growing up?  *

What does abundance and wealth mean to you? *

How is your mom’s relationship with money? *

How is your dad’s relationship with money?   *

Money Motivation

What am I willing to do for no money?   *

What would I like to do for a lot of money?  *

If money had nothing to do with my life, what would I do with my time?  *

What amount of money would give me the security I need?  *

What amount of money would I need to have choices?   *

What amount of money would I need to have financial freedom?  *

What amount of money would I need to really make a difference for the better?  *

Abilities // Capabilities

List all the things you are good at.  *

List all the knowledge you can teach people.  *

What do you believe to be possible for your life   *

List all your personality strengths *

What accomplishments have you achieved up to this point? This is your time to brag about you.  *

Focus

In your free time, what are you currently spending your time doing? *

What does your regular daily schedule look like?  *

What would you like to be spending your time doing?   *

What type of learner do you consider yourself to be? Visual? Auditory? Kinesthetic?   *

What is the first thing you want to focus on with this program? *

What do you NOT what to focus on?   *

Achievement

What do you have to contribute to this world that is unique to you? *

What does your ideal career look like?   *

What are you committed to doing?  *

What have you achieved in your past that will give you confidence to build a successful career or life?  *

What do you believe is possible for your career & life?  *

What is the outcome you want for your career? *

What will you see, hear and feel what you have it?   *

What does success mean to you?  *

How will you feel when you achieve that success?  *

Challenges

What are all the things you want to learn but haven’t been able to yet? *

What are you curious about within yourself and your life? *

What are the main areas of challenge in your life? Why did you sign up for this program?   *

What is currently blocking you from your growth?   *

What are 3 possible things you can do to move around that block?  *

What will stop me from taking action?  *

What fears come up around building the life you desire? *

What are the crippling narratives that play on repeat in your head?   *

Feedback

How do you handle constructive criticism?   *

What would support look like?  *

What do you expect from your coach?   *

How do you handle success?  *

How do you like celebrating your wins? *

What is your relationship with scheduling flexibility? *

Risk

How do you feel about taking risks?   *

What are you afraid of when it come to building the life you desire? *

What is the biggest risk you have taken in your life? *

What was the last risk you took?   *

How would it feel if you were able to get past your fear? *

What would make that fear disappear? *

Play & Rituals

What do you do that lights up your soul? *

What activities have meaning to you? *

What is one event or activity that made you feel most alive? *

What daily rituals do you have? *

What are 5 things you have been wanting to try but have not yet? *

Health

Is there any reason why should not follow a regular exercise and nutrition program? If yes, please explain. *

Do you smoke? Amount/Frequency *

Respiratory Health. Check all that apply.

Asthma
Respiratory/Pulmonary Conditions
Shortness of breath with exertion

Is there any reason why should not follow a regular exercise and nutrition program? If yes, please explain. *

Reproductive System

When was your last menstrual cycle? *

Do you get excessive bleeding during menstruation? *

Do you have or ever had ovarian cysts? *

Do you have or ever had fibroids? *

Do you get sore breasts during menstruations? *

Do you have low or excessive sex drive? *

Have you had any children? *

Have you ever had a miscarriage? *

What is your preferred cardio modality? *

How long per day do you do cardio? *

What does your typical week of training look like? (list your training routine from Monday through Sunday even including rest days) *

Approximately how many hours a week do you do other types of physical activity? (e.g. housework, walking to school or work, home repairs, moving around at work, gardening)

Nutrition

What does a typical day of eating look like? *

Average Daily Caloric Intake *

Do you usually cook or eat out? Are you comfortable with cooking? *

What are your strengths when it comes to nutrition? What are you weaknesses? *

Stress & Recovery

Think about all the activities you‘re involved in (e.g. work, school, caregiving, housework, travel). Then asses as best you can

On average, how many hours per night do you sleep? *

How do you normally cope with your stress? *

Mindset

How is your energy level? *

When do you feel the lowest amount of energy? *

When was the last time you got acupuncture if ever? *

Think Big

Paint me a picture and make it fancy! Think BIG! Think HUGE! Tell us what you will see, hear and feel when you have it. What do you want your life to look like after this mentorship and mastermind? *

How are you willing show up over the course of this program? *

What is your intention for this program? *

What is one word you will use to guide you through this program? *

What do you want to receive from your mentor & coach? *

If for any reason you fall off commitment… how do you want to be called back into committing to this journey? *

Anything else you feel will help us, guide you through your breakthrough? *