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Birthday
Jour
Mois
Année

Answer the questions below to the best of your abilities. If there's a question that you don't have a clear answer to, you can write that you are not sure or the answer is not yet clear.

Which area best describes what you’re looking to improve right now?

Type of Accompaniment
Self (habits, discipline, clarity, emotional control)
Relationships (communication, connection, conflict)
Leadership / Work (decision-making, influence, direction)
Personal growth in general
Not sure yet

What is the main challenge you're currently dealing with?

What would meaningful progress look like for you; What would you like to see change in the next 3–6 months?

How much time are you willing to commit to our work per week?

Single choice
1–2 hours
3–5 hours
5+ hours

Anything else you'd like us to know?

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