Please answer these questions with honesty and precision.
All responses are strictly confidential and will be reviewed personally by Ben.
First name, last name *
Phone number *
Email address *
Please briefly describe your current context, professional and personal *
What is/are the main challenge(s) or symptoms you’re facing at this stage? *
What have been your attempts to solve this problem so far, if any? *
What would you like to gain or resolve through this process? *
How will you know specifically when you have successfully achieved your goals? *
What do you feel are the obstacles that have been preventing you from achieving your goal? *
Is there any specific reason why you feel this work is right for you at this moment? *
This program requires commitment and personal involvement. Are you ready to invest yourself fully in this process to create meaningful changes? * Yes, absolutelyPossibly, depending on timingNot right now
Is there anything else you’d like Ben to know?
