Let’s get started!To successfully engrain your habit, please provide as much information as possible. Name * First Name Last Name Email * Phone (###) ### #### Tell us about your life in as much detail as you think would be helpful. * Please be sure to include some information on your home/personal life, professional, and social activities. What do you do for fun? * Do you have any addictions? (can include non-traditional addictions like sugar, gaming, etc.) What services are you interested in? * Emotional Environmental Intellectual Occupational Physical Social Spiritual other Is there a specific habit or goal you want to work on? * How frequently are you currently reaching this goal / engaging in this habit? What have you already done in an attempt to reach your goal(s)? Why do you think you have struggled to succeed in this area? What do you hope to accomplish from working together? * List at least 5 things you want to have, be, or do in your life. Dream big here, there are no limits! * What behaviors and beliefs are limiting or preventing you from realizing these things you want in your life? * How would my life be different if I achieved these goals? * Thank you!
