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WMM Intake Form

Play out BIG and go get ‘em!!!

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Question 1 of 12

What is your intention for this one-on-one mentorship program?

Question 2 of 12

What do you feel is your biggest challenge at this time?

Question 3 of 12

What are the challenges you would like to resolve by the end of this mentorship program?

Question 4 of 12

Is there anything that is important for me to know about you or your current situation?

Question 5 of 12

What led you to seek support NOW with your current life situation?

Question 6 of 12

What is/are the most disruptive/painful situation(s) you are experiencing currently which you would like to resolve and evolve from NOW?

Question 7 of 12

What relationships are currently working in your life and Why? Be specific.

Question 8 of 12

What relationship(s) is/are currently NOT working in your life and Why? Be specific.

Question 9 of 12

What would your ideal love life with your partner look like?  Why do you think you are not living it currently? Be specific.

Question 10 of 12

Which are the most important relationships in your life? Out of those, which one(s) is/are not a 10 out of 10 and what would you be willing to do to get it/them there?

Question 11 of 12

Describe in detail how does your love partner describes/sees you. What things make you feel appreciated, loved and cherished by her? What things make you feel unappreciated and criticized by her?

Question 12 of 12

Being the successful, driven man you are… What would be the cost/loss to you if the things you have shared thus far were not to be addressed and resolved NOW?  What would your life feel and be like? What kind of impact would you have on your personal and professional circle if you were not to succeed in these areas despite all of your other successes? Be specific and feel into it.

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