First Name *

Last Name *

Email *

Phone *

There are 3 sections of questions with a total of 19 questions.

FIRST SECTION

(Questions1-6)

1. Tell me about your family. *

2. Tell me about your career/ job/ education. *

3. What is your spiritual belief system in general? *

4. What practices do you do to grow and take care of yourself? *

5. Have you ever participated in a self-development class / course / program? If so, how did it make a difference? List and describe up to 3. *

6. Have you had, or do you have, a therapist / counsellor? If yes, tell me about that. If no, have you ever wanted to have a therapist/ counsellor? *

SECOND SECTION

(Questions 7-11)

7. Have you read the Holding Space Practice (HSP)book? *

Yes

8. Have you ever done a HSP workshop or course? *

Yes

9. Are you receiving the HSP Learning Series emails? *

Yes

10. Do you have a HSP mentor already? *

Yes

Have you seen the bios of the HSP mentors? (https://holdingspacepractice.com/intro-to-mentors) *

Yes

If you have not seen the mentor bio page, please pause and read that page so you can answer the next question.

11. Which mentor do you think would be the best fit for you to work with? *

Adriane

Carol

Emily

Melinda

THIRD SECTION

(Questions 12-19)

The following questions are to help you sort through your thoughts about where you are at in your growth and personal transformation. Question #19 is meant to be the summation of questions 12-18. Move quickly through this worksheet. Spend less than a minute per line. This is meant to just take your current temperature.

12. What is one thing that, if it changed, would have a huge impact on you? *

13. What are the challenges or blocks that make it hard to make this change? *

14. If this were to change, how would your life be different? *

15. What would the first step toward this change be? *

16. How much time are you willing and able to invest each week to experience this transformation. *

17. What is this change worth to you? ($, time, energy) *

18. If you don’t make this change, what will it cost you? ($, time, energy) *

19. Summary question: What do you hope HSP can help you with? *

Sign below if you agree with this statement: "I am ready to ready to commit to my transformation and work toward my vision. and, I agree to be contacted by a Holding Space Practice Mentor." (In the last question, indicate if you prefer email or text communication to set an appointment for a phone call. ) *

Clear

I prefer initial contact via *

text