🧠 THE IDENTITY RESET COACH™

CLIENT INTAKE FORM

This form helps me understand where you are in your personal growth journey and how The Identity Reset Method™ can best serve you.

Please answer honestly — there are no wrong answers.

Once submitted, you'll be contacted to schedule your Clarity Call.

🔹 PERSONAL DETAILS

Name *

Email Address *

Phone Number *

Best way to reach you *

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How did you hear about me?

On a scale of 1–10, how clear are you about who you truly are beyond your titles, roles, and responsibilities?

Not clear at allVery clear5

What area of your life do you feel most stuck or unclear in right now? (Select all that apply)

Describe a recurring thought, habit, or pattern that keeps holding you back.

Examples: "I constantly doubt my decisions," "I people-please to avoid conflict," "I feel like an imposter in my success"

What would "resetting your identity" look like for you?

On a scale of 1–10, how committed are you to doing the inner work it takes to experience a transformation?

Not committedFully committed5

Have you ever worked with a coach, mentor, or therapist before? If yes, what was that experience like?

What made you decide to reach out now for coaching with The Identity Reset Coach™?

How would your life look or feel 90 days from now if you truly reset your identity?

On a scale of 1–10, how important is it for you to experience a breakthrough this year?

Not importantExtremely important5

What's your biggest fear about coaching? (Select all that apply)

When are you hoping to start your transformation journey?

(Optional) If faith is part of your journey, share how you believe God is leading you to this coaching experience:

On a scale from 0%–100%, how ready are you to invest in your transformation right now?

0–30% — Just exploring40–70% — Curious but cautious70–85% — Ready to invest and grow90–100% — ALL IN, let's do this!