Individuals Consultation Application Brisbane

1. Personal Details

Name *

Age *

Occupation *

2. Responsibility for Life Outcomes

When things go wrong in your life, what is your first response?

I analyse what I could have done differently I blame circumstances I blame other people I avoid thinking about it

How much of your current life situation do you feel responsible for?

Most of it — my choices have shaped where I am Some of it — but external factors have played a big role Very little — my circumstances have largely been outside my control I'm not sure

Is there a specific area of your life where you find it hardest to take ownership? If so, describe it briefly.

3. Emotional Triggers

What situations or people most commonly trigger a strong emotional reaction in you?

Think about recurring patterns — not just one-off events.

How do you typically behave when you are emotionally triggered?

I react immediately and often regret it I suppress it and move on I withdraw and go quiet I can usually pause and respond thoughtfully

4. Discipline Habits

How many minutes per day do you currently spend developing your mind?

None Less than 10 minutes 10–20 minutes More than 20 minutes

Which of the following do you currently practise consistently? (Select all that apply)

Regular exercise Structured sleep routine Daily reading or learning Journaling or reflection Meditation or mindfulness None of the above

When you set a personal goal or intention, how often do you follow through?

Rarely — I struggle to maintain momentum Sometimes — I start well but fade Often — I usually follow through Consistently — I hold myself accountable

5. Life Goals

Do you currently have clearly defined goals for the following?

Describe your goals in each area, or leave blank if not yet defined.

Daily behaviour

Weekly progress

12-month direction

5-year life direction

Which life areas do you most want to improve? (Select all that apply)

What is driving you to pursue these goals right now?

What has made this the right moment for you?

6. Current Challenges

What is the biggest challenge you are currently facing in your life?

How long have you been dealing with this challenge?

Less than 3 months 3–12 months 1–3 years More than 3 years

What have you already tried in order to address this challenge?

7. Avoidance Patterns

What is the biggest thing you believe you may currently be avoiding in your life?

How do you most commonly avoid discomfort or difficult situations?

Procrastination — I delay indefinitely Distraction — I keep myself busy with other things Rationalisation — I convince myself it doesn't matter Social withdrawal — I pull back from people I don't tend to avoid — I face things head on

What do you think this avoidance has cost you?

Consider relationships, opportunities, self-respect, or time.

8. Commitment to Behavioural Change

Personal change requires disciplined practice over time.

Are you prepared to commit to consistent behavioural change? *

Yes No Unsure

What does commitment look like for you on a practical level?

How much time per week are you realistically able to dedicate to this work?

Less than 1 hour per week 1–3 hours per week 3–5 hours per week More than 5 hours per week

What do you believe is your biggest internal obstacle to changing?

This could be a belief, a fear, a habit, or a pattern of thinking.

Have you worked with a coach, mentor, or therapist before?

Yes — and it was helpful Yes — but I didn't get much from it No — this would be my first time

All information provided in this application is treated as private and confidential and managed with professional discretion.

I understand and acknowledge this. *

✓ Thank you. Your application has been received. We'll be in touch shortly.

Individual Application Questionnaire

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