Strategic Clarity Intake Form

First name

Which of these feels most true right now?

I feel mentally scattered and pulled in too many directions.

I feel constant pressure and rarely feel fully recovered

I'm doing a lot, but my life doesn't feel like it's truly moving forward

Which of these feel most familiar lately?

I feel guilty resting when things still need to be done

I keep functioning even when I know I'm exhausted

I struggle to fully disconnect mentally

What area of your life is being most affected right now?

My physical energy

My ability to think clearly

My relationships or emotional availability

My consistency, direction, or long-term vision.

If nothing changes in the next 6 months, what concerns you most?

What feels most true right now?

Im ready to make meaningful structural changes

I know something needs to change, but I already feel stretched thin

I need clarity before I start changing things

I've tried to make changes before, but I struggled to sustain it

I'm not fully sure what I need yet, but I know this current pattern isn't working

**You're not expected to have everything figured out before this session.

The goal is to help us see more clearly what has been shaping your life so we can begin restoring order, direction, and space for something different to emerge.