If you would like an initial consultation, please fill out this questionnaire.

1. Into which category do you fall?

I'm well off financially.
I'm building my career.
My retirement is in sight. If I continue to work, it will be voluntarily.
I'm going to need to work well into my seventies.

2. How would you rate the quality of your life on a scale from 1 to 10 (10 being great)?

1 to 3
3 to 5
5 to 7
8 to 10

3. Rate the stress in your life on a scale from 1 to 10 (1-low & 10-high)

1 to 3
3 to 5
5 to 7
8 to 10

4. Was there ever a time in your work life when you really had fun?

Yes
No

5. Are you ready to do the work necessary to restore this joy in your work life?

Yes
No

6. Would you like an initial consultation?

Yes
No

Your name:
E-mail address:

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