The Clarity Breakthrough Intake Form

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Client Pre Call Questionnaire

Please fill out as completely and accurately as possible. This information is very important to you receiving the best possible coaching session on our call.

Pricing & value

Confidence/Impostor Syndrome

Marketing/Messaging

Decision-making

Boundaries & time management

Fear of visibility or failure

Are you open to mindset + strategy coaching and direct feedback?

Yes

No

I’m open but nervous

On a scale of 1–10, how ready are you to take aligned action after our session?

1 (hesitant)

2

3

4

5

6

7

8

9

10 (all in)

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