The Right Room

Inner Circle
Intake Form

Complete this before your first call. The more honest you are, the more powerful your first session will be. There are no right or wrong answers.

About you

Full name *

Date of birth *

What do you do — occupation or what you're building *

The beliefs and story running underneath everything. This becomes the foundation of the clearing work.

How would you describe yourself honestly — not who you want to be, who you actually are right now? *

What do you believe about yourself when things get hard or don't go to plan? *

What labels or stories have you carried about yourself for a long time — whether from others or yourself? *

Where do you think those beliefs came from? *

Your current relationship with your inner world — how self aware you are and how open you are to the deeper work.

How would you describe your mindset on a day to day basis? *

What does the voice in your head say most often — about yourself, your ability, your future? *

Have you ever explored hypnosis, meditation or visualisation? If so what was your experience? *

What do you think is actually holding you back — not the surface reason, the real one? *

How clear your vision is — whether you're operating from a real picture of where you're going or reacting to life day to day.

Where do you want to be in 12 months — across all areas of your life? *Think across business, mindset, relationships, health, how you feel every day.

Who is the version of you that has all of this handled? Describe him. *

What would your life feel like if you were fully expressed and operating at your best? *

What do you think needs to change most to get there? *

How you show up day to day, where your energy goes, and what your current standard looks like in practice.

What does a typical day look like for you from morning to night? *

Where do you feel most inconsistent or like you're operating below your potential? *

What habits or routines do you currently have — and which ones are you missing? *

How would you describe your energy levels and focus on a daily basis? *

Who you're around, what standard that sets, and whether your environment is lifting or limiting you.

Who are the five people you spend the most time with and how do they influence you? *

Does your current environment push you to a higher standard or keep you comfortable? *

What does the conversation around you typically sound like — what gets talked about most? *

What kind of environment do you want to be in and what does that look like? *

Gauge readiness, seriousness, and what success looks like. This shapes everything that follows.

What do you want most from your time in the Inner Circle? *

What are you willing to commit to this process? *

What would make this the most valuable investment you have ever made in yourself? *

Why now? *

"The more honest you are here, the more powerful your first call will be."