Mentoring Intake Form

First Name

Last Name

My body temperature is lower than 98.6°F/ 37.5°C

Are you experiencing any flu symptoms?

Yes

Date

Initials

All the information you submit on this intake will be kept confidential. Upon submitting this form, all answers in the boxes will be sent directly to Karen Hale's personal email, This information will only be seen by Karen Hale. You can reserve the right to not disclose your personal history. It is solely up to you which questions you choose to answer. However, all fields are required to have an answer. If you choose to not answer please type, "No Answer" in the field.

Personal History Questions

If you could have anything your heart desired and everything was possible, what would your dream life look like? Use your feeling and emotional body to contact clear, descriptive adjectives that describe your dreams. This will also invoke the subconscious minds creative capacity to expand beyond your currently reality.
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I confirm that the information given in this form is true

Thanks for submitting!