Your Om Client Intake

1

*Please choose your preferred language of the form (EN | DE) in the top right corner of the screen
*Bitte wähle deine bevorzugte Sprache des Fragebogens (EN | DE) in der oberen rechten Ecke des Bildschirms

Your journey is already starting right here, right now. Every Coaching Journey is completely bespoke for you. Your answers will help me to get a sense of how I can support you during our time together in the best way possible.

I invite you to take a moment to prepare your space for answering the following questions. Make yourself feel comfortable. Do you want to light a candle or incense? Maybe prepare a cup of coffee, tea, or matcha?

This form is infused with loving energy. I invite you to consider it a safe place where you can be completely honest. If you don't feel like answering a question, just add some random letters there. I will treat your answers confidentially and will not pass them on.

Take a deep breath.

Let's start 💜🙏🏽

If you have any questions, you can contact me here:
Mail: lisa@your-om.com
Instagram: https://www.instagram.com/live.your.om/
Telegram or WhatsApp: ‭+4915792368871‬
2
Full Name* This field is required.(and what you prefer to be called e.g. Lisa Marie Kuehn, Lisa)
3
eMail* This field is required.
example@example.com
4
Phone Number* This field is required.e.g +49 15712345678
Country Code
Phone Number
5
Time Zone* This field is required.e.g. Time zone in Ubud, Bali (GMT+8)
6
Your Birthday and Time* This field is required.If you don't know your time, please insert 0:00
Date
Year
Month
Day
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
7
Your Birth Place* This field is required.
8
Instagram Handle & Website (if applicable)
Instagram
Website
9
Profession / Working hours per week* This field is required.
10
How did you find me?* This field is required.
11
Where are you in your life right now? What has led you here?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
12
How is your living situation right now? Where do you live? Is someone living with you? Do you enjoy this constellation?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
13
How would you describe your childhood? What was it like? With whom did you live? What memories do you feel are essential to share with me for our time together?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
14
Please describe any recent life changes.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
15
Do you have any previous illnesses (physical or mental)?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
16
On a scale of 1-10 tell me your quality of life right now.* This field is required.
17
What do you consider masculine? Tell me anything that comes up.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
18
What is your relationship to 'the masculine' like? For example, your relationship to giving, assertiveness, confidence, willpower, power, your father, and anything else you consider masculine.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
19
What do you consider feminine? Tell me anything that comes up.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
20
What is your relationship to 'the feminine' like? For example, your relationship to receiving, allowing, surrender, receptivity, sensuality, beauty, your mother, and anything else you consider feminine.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
21
What are the top 3 - 5 values you want to live by? Why these?* This field is required.Mine are ease, freedom, intuitive flow, self-experience, and trust.
Huge
Large
Normal
Small
Ok
Ok
22
What do you know you're currently believing that is no longer serving you?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
23
What do you believe about the human experience? Why are you here? What is life really about?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
24
What is your relationship to your body like?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
25
What is your relationship to your soul like?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
26
Do you feel connected to your intuition and your heart currently? Describe the connection as it is now, and how you'd like it to be.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
27
Have you worked with a coach and/or psychotherapist before? Tell me about the experience...* This field is required.
Huge
Large
Normal
Small
Ok
Ok
28
What is it that you wish support with? * This field is required.Maybe it's a specific situation in your life or a general theme.
Huge
Large
Normal
Small
Ok
Ok
29
If it was your soul answering now, what would she want to add to your previous answer?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
30
What do you most hope will happen as a result of our work together? Please detail desires that you feel comfortable sharing. And also desires that feel uncomfortable.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
31
Why in particular are you drawn to working with me?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
32
Is there anything else you would like to tell me that you consider important for our time together?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: