Real Talk with Dr. Pete · Client Intake Form
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Real Talk with Dr. Pete
Get Real · Get Empowered

New Client Intake Form · Part 1 of 2

Before we can go forward,
we go deep.

These questions are designed to get to the root — not the surface. There are no right answers. The more honest you are, the more powerful our first session will be.

Section 01

Who You Are

The basics — so we can put a full picture to the person showing up.

Section 02

Where You Are Right Now

No sugar-coating. We need the real picture of where you're starting from.

Question 01

"If I'm being completely honest, the biggest thing holding me back right now is..."

Don't edit yourself. Write the first thing that comes to mind, even if it feels embarrassing or small.

Question 02

"The moment I feel most like a fraud is when..."

Think about a specific situation — a meeting, a conversation, a room you walked into. What triggers that feeling?

Question 03 · Rate your confidence

"In professional settings, my confidence level is usually..."

1 = I shrink and go quiet. 10 = I own every room I walk into.

I shrinkI own it

Question 04 · Select all that apply

"The situations that make me feel most out of place or unsure of myself include..."

Check everything that resonates, even if it surprises you.

After submitting, click below to continue to Part 2.



Continue to Part 2 →

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