ALTworkspace

ReInvention LAB ... Client Intake Form

Complete this form before your first session. Be honest; be specific. The precision of your answers directly impacts the precision of your results. Everything shared here is confidential.

There are no wrong answers. If a question feels uncomfortable, that is usually a signal worth paying attention to.

1. Contact and Personal Details

2. Billing Details

Complete if different from above, or if invoicing to a business.

3. Birth Data

Used to provide personally specific advice using your natal chart. If you do not know your exact birth time, provide your best estimate and note that it is approximate.

4. Health and Wellbeing

RTT and subconscious work can surface physical and emotional responses. This information helps me work safely and effectively with you.

(e.g. depression, anxiety, PTSD, bipolar, personality disorders)

5. Where You Are Now

Be direct. I am not here to judge your situation; I am here to help you change it.

What is your current professional role or business?
In one sentence, what is the primary thing that feels stuck, stalled, or misaligned right now?
How long has this been the case?
What have you already tried to fix or shift this? Be specific.
What do you think the real problem is... underneath the surface-level description?

6. What You Want to Overcome

Name the patterns, blocks, and behaviours that are costing you. The more precisely you can identify them, the faster we can recode them.

What is the single biggest internal block holding you back right now? Not the external circumstance. The internal pattern, belief, or response.
When this block is active, what does it cost you? Think in terms of money, time, energy, relationships, opportunities, health, confidence.
If you could trace this pattern back, when do you think it started? What was happening in your life?
What belief about yourself do you suspect is running underneath this pattern? Example: "I am not safe unless I control everything." or "If I slow down, I will lose what I have built."

7. Designing Your Next 90 Days

If you could create anything... without limitation, without judgement, guilt or shame, without needing to know the how... what would you design for your life in the next 90 days? Be as specific as possible. The subconscious responds to precision, not vague intentions.

For Sections 7 & 8: Answer what you can & we can work through the rest in your first session.

If there were zero constraints on your time, money, location, or identity... what would your life look like 90 days from now?
Describe your ideal client, customer, or professional opportunity in detail. Who are they? What do they value? How do they find you? What makes them a perfect fit?
Describe your ideal daily reality in detail. What time do you wake? What does your morning look like? How do you spend your energy? Who are you with? What have you stopped doing? What is effortless now?
What is the single most important outcome that, if achieved in 90 days, would make everything else easier or irrelevant?
What is the last thing that has to happen so you know you have achieved it? Be precise. Not a feeling. A specific, observable event or result.
Who in your existing network, once they see your transformation, would become a natural advocate or referral source for you?

8. The Shift: Now vs. 90 Days

If everything you described in Section 7 were achieved... what would be different? Complete both columns honestly. The left column is not a criticism; it is a baseline. The right column is not fantasy; it is a design.

NOW / TODAY 90 DAYS FROM NOW
Feelings
Thoughts
Actions
Energy
Relationships
Career / Business
Finances
Health
Identity
Daily reality

9. Readiness and Commitment

On a scale of 1 to 10, how committed are you to doing whatever it takes to achieve what you described?
If your answer is less than 10... what would need to change for it to become a 10?
What are you most afraid of in this process?
What will it cost you if nothing changes in the next 12 months?
Is there anything else you want me to know before we begin?

10. Consent and Acknowledgement

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that RTT and subconscious pattern work are not a substitute for medical or psychological treatment. I understand that results vary and that my active participation and commitment are essential to the process. I consent to my sessions being conducted primarily online and confidential recordings will be provided. I acknowledge that all information shared will be kept strictly confidential, except where significant risk to self or others is apparent. You can refer to the IIC Therapists code of conduct if more info is needed. I understand that payment is required upfront and sessions may be cancelled if payments are not processed prior.