CLIENT INTAKE FORM Name * First Name Last Name Email * What’s your Breakthrough Goal? That’s the one thing on your list, that if you focused on it — to the exclusion of everything else — it would be most likely that you’d accomplish everything else, anyway? * What are the biggest obstacles in the way of you getting what you want? * Imagine we meet up 1 year from today, and you are looking back over that year. You say, “Wow! I’ve just had the best year of my life.” Tell me about that… * Is there anything else I need to know before we get started? Thank you and I look forward to supporting you!