Name *

First Name

Last Name

How would you rate the UNDERSTANDING you have on your dharma (1 = No idea what my purpose is; 5 = Complete understanding of my highest purpose) *

1

2

3

4

5

How would you rate the CLARITY you have on your dharma (1 = No Clarity; 5 = Full quality or state of being clear) *

1

2

3

4

5

How would you rate the INSIGHT you have on your dharma (1 = No insight; 5 = Full capacity to gain an accurate and deep intuitive understanding of a person or thing) *

1

2

3

4

5

How would you rate the PERSPECTIVE you have on your dharma (1 = No perspective; 5 = True understanding of the relative importance of things) *

1

2

3

4

5

How would you rate the sense of DEVOTION you have on your dharma (soul purpose) (1 = No Devotion; 5 = Complete love, loyalty, or enthusiasm) *

1

2

3

4

5

Please read carefully: I understand that a Coach does not diagnose or treat any mental or physical illness. A Coach is a mentor and guide helping clients reach their own goals by helping clients to devise and implement positive, sustainable lifestyle changes. I further understand that a Coach is not acting in the capacity of a doctor, psychologist, licensed dietician-nutritionist, or other licensed or registered professional, and that any advice given by the Coach is not intended to take the place of advice by these professionals. *

I understand the message above and agree to proceed

I do not wish to proceed