mPEAK Coaching Intake Assessment

These questions are designed to make you stop and reflect so please take your time. If there is a question that you're having trouble answering, skip it and come back to it before you press submit. If you feel there are repetitive questions you can either go deeper or just refer to a previous answer. When complete, press "submit" and then review the paperwork, download the guided audio meditations and proceed to payment. Thank you for inviting me to be on this adventure with you.

Name *
Name
Address
Address
Phone
Phone

Paperwork

Please read these two documents. Save the paper, an email acknowledging that you’ve read and agree is sufficient.

Policies & Procedures

Client Agreement

guided meditation

Download the mPEAK guided audio meditations to your computer and device or find the meditations on the Insight Timer App.

Payment

Please send check to Pete Kirchmer to: 227 Neptune Ave. Encinitas, CA. 92024 or pay by credit card below.