New Client Request

Email*

How would you like to be called?

Gender*

Month and Year of Birth*

Current Community (City and State)*

Relationship status*

Employment Status*

Do you agree to a minimum of 30 minutes per day in contemplative practice?*

Yes

Do you identify as any of the following?

BiPOC

LGBTQIA+

Disabled

Addict

Are you under the care of any of the following?*

Medical Doctor

Mental Health Professional

I am currently not in care

If you have a spiritual identity or practice, please describe below.

Trauma Informed

To provide support in a way that acknowledges and responds to the potential impact of past traumatic experiences and minimizing risk of re-traumatization by creating a supportive environment on trust and choice.

Have you ever experienced trauma or a traumatic event?

Yes

Maybe

What are some situations or people that might bring up memories of trauma?

How does your body or mind feel when you are activated?

What helps you when you are feeling unsafe?

The self assessment below is designed to promote self-awareness and introspection.

Take your time to reflect on the questions. During our initial coaching session, your responses will be reviewed to create a personalized action plan that addresses your unique needs and goals. Your openness and honesty are valued and will contribute significantly to the success of improving your success and well-being.

What goals would you like to achieve in the Transformational Mindset Coaching program?

Why is it important to accomplish your goal? What is motivating you?

Have you tried to change before? If yes, what have you tried that didn't work?

How can Trinity support you in achieving your goals?

What does successfully reaching your goals look like to you?

Describe yourself in five words or less

Name three of your strengths.

Name three of your weaknesses

Are there any persistent negative thoughts or beliefs you would like to address?

What do you like to do in your free time?

Do you feel you live a healthy lifestyle? Why?

Describe your support system, if any.

Name up to three things you have to put up with in your life.

Is there anything else you would like to share?

Terms and Agreements
Please check on each box to communicate understanding and agreement.

I understand that services offered by Trinity Mystic are a pay what you can model that encourages generosity. As a client, I will make best efforts to create reciprocity in the relationship.

I understand that services offered by Trinity Mystic are at will, and either party can terminate the relationship at any time without advance notice. Behaviors that are subject to termination include: bullying, hate speech, lack of reciprocity, lack of engagement in the process, two or more late or no shows. I understand that my success is contingent on actively participating in practices to improving my life and circumstances. I am free to reject or terminate support at any time.

I understand that Transformational Mindset Coaching is not a form of medical or psychological practices. I understand that Trinity Mystic is not diagnosing, prescribing for, nor treating any physical or medical ailments or conditions and I do not hold her responsible for them. Services by Trinity Mystic are provided to encourage education and self-improvement. Please consult with your medical doctor, psychiatrist or psychologist prior to making any lifestyle changes that may impact your current medical treatment.

I understand that ideas, techniques, practices, etc. offered and discussed are the viewpoint of Trinity Mystic. All information provided should be mindfully considered and should not be taken as the only truth. Everyone has a unique reality and all points of view should be respected and honored. Trinity Mystic wholeheartedly embraces diversity and is committed to providing a safe and inclusive world for all.

Transformational Mindset Coaching may produce emotional and physical responses that may be unexpected and of a highly personal nature. I agree to inform Trinity Mystic of all physical or mental conditions which may affect our work together. I understand that receiving support may respectfully involve divination, shamanic journey, distance healing, energy medicine, and I give Trinity Mystic permission and consent to do so for my benefit.

Transformational Mindset Coaching is a personal growth and alternative healing art. I am fully committed to creating changes to increase happiness and well-being. I agree to be honest and forthright with Trinity Mystic about Transformational Mindset Coaching ideas, emotional responses, and affects.