YES! I want to discover and resolve the root cause of my life challenge! Here's my application...

YES! I want to get unstuck or get through my life challenge! Here's what I understand about my situation so far...
The first step in me helping you is to gain some essential background.

The 5 minutes it will take you to fill in this form will be invaluable and enable me to know the best next step.

Rest assured all details are sent directly to me and completely confidential.

Here's to your transformation! :)

Kim
Personal Details
Name *

First Name Last Name
Occupation *
How did you hear of Kim Knight Health? *
E-mail *
Skype *
(if no skype ID, put 'none')
Phone Number

- Area Code Phone Number
Country and time zone *
Age *
Your Situation
What issue or life challenge is turning up in your life that you no longer want or need help with? *
What does this issue or life challenge prevent you from doing, being or having? *
What will your life look like once these issues are resolved? *
What are the obstacles preventing you from reaching your ideal outcome? *
What are the costs of staying where you are (energetically, emotionally, financially)? *
On a scale of 1-10 how ready are you for a breakthrough in your situation? *

1-3 Not that fussed, I can put up with this a while longer 4-6 I'm getting ready to having had enough 7-9 I'm pretty keen, it's really disrupting my life 10 Absolutely 100% committed to change right now, I'm ready

If applicable, please tick if you have been diagnosed with, or suspect you may be experiencing, one or more of the following health conditions:

What other life issues are turning up in your life?:

	None	Slightly / Occasionally	Moderate amount	Far more than I would like
General unhappiness
Self-sabotage
Addictions
Stress and overwhelm
Low self-confidence / self-worth
Not feeling good enough
Inability to speak truth
Fear of failure
Fear of success, fulfilling potential
Other

Other issue(s) not listed above
What other approaches have you already tried to resolve this issue? What difference have they made? *
Working with Kim is a deep and powerful transformational experience. Are you ready to invest the time, energy and money in yourself to make this happen *
How ready are you to invest the time, money and energy into reaching this outcome so that you finally have the freedom you have been looking for? *

I'm just curious, not really ready yet I'm pretty keen, not quite 100% certain I'm 100% ready!
How much are you willing to invest in achieving the change you are looking for? *

Less than $1000 $1000 - $3000 $3000 - $6000 $6000 - $10,000 Whatever it takes
Are you ready financially and emotionally to invest in the personal support and guidance of a coach? *

Yes No
Is there anything else I should know before we take the next step?
Thank you so much for taking the time to share this information. I will be in touch very shortly by email.

Cheers! Kim
Should be Empty:

YES! I want to get unstuck or get through my life challenge! Here's what I understand about my situation so far...