Client Application

Welcome to the first step in achieving your success!

You’ve made an important decision to help yourself move forward. Now, in order to make sure we would be of benefit to you and then to customize your experience, please fill out the form below. We continually review applications. You will receive an email outlining your status and if we are a match, as well as an email when a space becomes available.

(ThisTimeIMeanIt can only handle a limited number of individuals. This will help us determine if we could be of service to you.)


Please enter your full name. If you have a nickname by which you would prefer to be called, please put it in "quotation marks" after your name.



Please enter your email address.



Please enter your phone number. It will not be given to anyone but will be used for our telephone calls..<br>



Please enter your birth date "xx/xx/xxxx" although the year is not necessary. (Of course, there's no reason to be ashamed about a long life is there?)



How will you know you're successful? Please give as much information as you're willing to share on what you would like to accomplish with TTIMI.



Focus on the feelings: sad, mad, glad, afraid. Write from "first person," such as "I feel." Some people are not as comfortable talking about "feelings" and are more about "actions." That's fine. There is no wrong answer however you fill this in. It just gives us more insights into what would help you.


What seems to be blocking you? If you could change anything in order to make it easier for you to achieve your goals, what would it be? Why can't you?







Although different goals will carry different levels of commitment, please put down your average "comfort level." This number indicates how you want to be "pushed" to achieve your goals? Enter a number between one & ten. Ten means you really want us to push hard on you, and challenge your assumptions when they seem wrong. One means you just want freedom to vent and do not want to be challenged. Five would be some pushing when needed but to back off if you show some resistance. Remember, in order to change, you will need to feel a little uncomfortable at times. However, even when challenged, it will be in a supportive manner and your desires are always the most important objectives. Please be honest; there is no judgment here.





If you have any problems, please don’t hesitate to get in touch.


Please fill out this simple form or call us TODAY at 707.442.6243.

Someone will get back to you quickly.

Please tell us who you are. (required):

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Tell us where you found out about Scott

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Finally, we do need to make sure you're a human. (Sorry.) enter the code below into the box and then click "send."

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If you cannot read this, please refresh the screen; if you still cannot use it, send an email to scottq(AT)thistimeimeanit.com

 

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