Questionnaire 1 of 2

Personal Questionnaire

* Indicates required field

Name *

First

Last

Email *

How long have you had this problem? What have you done about it? Did the things that you previously did, work? *

How intense are your feelings which are associated with the problem (on a scale from 1-10) with 10 being extremely intense? *

Can you get in touch with the emotions as we you type and think about this *

Do you ever feel positive/negative emotions? *

Feel free to elaborate on the negative and positive emotions *

Have you heard that you have an Unconscious Mind? *

Why do you want to let go of the problem? *

Are you at Cause for your creation of this problem? (Leisa Will Explain This Further) *

How will you know that the problem has disappeared at the end of our session(s)? What will you see, hear, feel, say to yourself when the problem has disappeared? *

What will happen when you get your outcome? What will you feel? How will your family (business associates) react to you letting go of your problem? *

We may give you some Tasking before we see you. You must do those tasks or we cannot see you. Do you understand? Is that OK? *

Submit

ADDRESS

3/373 Glen Osmond Road, Glen Osmond

Telephone

Jen 0406 939 090 Leisa 0438 520 219

Email

myintrinsicmind@gmail.com

Response

We aim to respond within 24 hours

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Personal Questionnaire

ADDRESS

Telephone

​​Email

Response

LinkedIn

Skype

Facebook

Instagram

YouTube

"Believe, Achieve, Succeed"

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