NUMEROLOGY CLIENT INFORMATION FORM

Please fill out this form and email it back to me at: info@KassandraBibas.com. Name __________________________________________________ Home Phone ___________________________ Work Phone ___________________________ Email Address ___________________________________________ Address _________________________________________________ City _____________________________________________________ State/Province ____________________________________________ Postal Code __________________ Occupation _______________________________________________ Title _____________________________________________________ Company _________________________________________________ Marital Status/children _____________________________________ Education _________________________________________________ Certificates/workshops/etc __________________________________

YOUR NUMEROLOGY
Numerology is over 10,000 years old with roots in Egypt and Babylonia. Traced back to Pythagoras, a mathematician, numerology believes that all things in the universe vibrate at specific frequencies. Frequencies can be captured by numbers. In this way, when you know a persons numbers, you know the frequency at which their lives vibrate throughout the universe. In other words, the numbers that represent when a person was born and what they were named at birth and throughout life didnt happen by accident. Destiny was in it and understanding those numbers speaks volumes about what that person was born for and how they move through life. Numerology is a way to figure out the spiritual lessons you came here to learn, how to connect and successfully work with others and how to experience your own life at your highest vibration.

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HOW NUMEROLOGY WORKS: All numbers are reduced to single digits 1 through 9 and all letters are broken down into single digits 1 through. There are, however, master numbers (ex: 11 and 22) which represent specific, higher vibrations. These numbers have their own meaning as double digit numbers. When numerology is calculated, one does so by breaking down the numbers of a persons birth date and/or name to a single digit. For example, a persons life path number is calculated by adding up all the numbers of his or her birthday. For example, if Jane was born on November 1, 1956, heres how we would calculate her Life Path Number: November breaks down to: 11 1+1+1+1+9+5+6 = 24 = 2+4 = 6 In this case, Janes Life Path Number is 6.

Below is a chart of how the alphabet breaks down into numbers:

1 A J S 2 B K T 3 C L U 4 D M V 5 E N W 6 F O X 7 G P Y 8 H Q Z 9 I R

A numerologist uses all of this information to speak to a person about his or her life circumstances, personality, relationships and destiny.

To develop your numerology profile, please fill out the following:

1. 2. 3. 4. 5. What is your birth date? What is your FULL birth name (the name listed on your official birth certificate)? What is your FULL current name? Any previous FULL names? (divorce, remarriage, etc.) If you would like numerology relationship profiles, please provide the FULL NAMES and birth dates of up to three individuals in your life who youd like to know whether you are a natural match to?

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YOUR HISTORY
6. Describe your three greatest accomplishments to date. 7. What made these accomplishments stand out for you? 8. What have you incorporated into your current actions from your past accomplishments? 9. How could you use what youve learned from these accomplishments to assist you in making future changes? 10. What major transitions have you had in the past two years? (For example, new assignment, new residence, new relationship, etc.) 11. If you worked with a coach before or a similar one-on-one adult relationship (for example, tennis coach, piano teacher, therapist), what worked well for you? 12. If you worked with a coach, and you are not currently, how did that relationship end?

YOUR LIFE
1. 2. 3. 4. Who are or have been your major role models? What attributes of these role models do you admire and want to emulate? What are the five most positive things in your life? What are five things you would like to change in your life that would make it even more satisfying, effective and joyful? (Examples include relationships, information, environment, job.) 5. Who are the key supportive people in your life, and what do they provide for you? 6. On a scale of 1 to 10 (1 being least effective and 10 being most effective), rate the quality of your life. _____ By what criteria did you rate yourself? 7. What percentage of the life you are leading is actually YOUR life?

YOUR SELF TODAY

1. 2. 3. 4. 5. 6. List five adjectives that describe you at your best. What prevents you from being at your best? What energizes you? What saps your energy? What are you learning and accepting about yourself at present? In what ways do you currently spend time, that if you were to spend it differently, would yield greater happiness and achievement? 7. What do you consume now, that if you didnt, would allow you to be healthier? (For example, alcohol, caffeine, sugar.) 8. Could therapy effectively resolve some issue in your life now?
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YOUR POTENTIAL
1. What is your personal and/or professional vision? 2. What would you like to contribute to the world? 3. What are you most wanting to achieve in the next three years? 4. What are you most wanting to achieve in the next six months? 5. How ready are you to go for it? LIFE VISION AREAS INCLUDE: Family/home Relationships Financial situation Career or business Self-care Personal Character Learning

MAKING IT HAPPEN
1. Why have you hired me? 2. What are three immediate changes you can make to get you off to a good start in our coaching? 3. How can I help you to be more effective in working toward your goals? Here are ways coaching clients work with me. Which of these appeal to you? (Select as many as apply.) Brainstorming strategies together Support, encouragement and validation Insight into who you are and your potential Painting a vision of what you can become or accomplish Exploring possibilities and building on past success Accountability; checking up on goals Suggesting or designing action steps that lead to greater effectiveness and joy 4. What approaches to change have you found less effective for you? 5. What responsibility do you have for ensuring that our relationship works well? 6. How will you know that your coaching experience has been effective? Thank you for filling out the form. Please email the completed questionnaire to Kassandra Bibas at info@KassandraBibas.com.

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