Personalized Affirmation Mantra – Client Intake Form Personal Information Full Name: Preferred Name/Nickname: Email: Phone: Date of Birth: Professional Background Current Role/Title: Industry: Years in Current Position: Company Size: Startup Small (1–50) Medium (51–500) Large (500+) Self-Employed Life Focus & Goals Top 3 Professional Goals: Top 3 Personal Goals: Challenges Imposter syndrome Leadership pressure Self-doubt Relationship issues Affirmation Preferences Preferred Listening Time: Early morning (5–7 AM) Morning commute (7–9 AM) Midday break (11 AM–2 PM) Evening wind-down (6–8 PM) Before bed (8–10 PM) Multiple times throughout the day Energy/Tone: Powerful and commanding Gentle and nurturing Confident and steady Inspiring and uplifting Grounding and calming Mix of energies Affirmation Style: "I am" statements "You are" statements Future-focused visioning Present moment awareness Mix of styles Audio Experience What type of background sound resonates most with you (if any)? None – voice only Nature sounds (ocean, rain, forest, birdsong) Soft piano or string instruments Ambient healing tones (etheric, spacey, atmospheric) Binaural beats or frequency-based (432 Hz, Theta waves, etc.) Gentle rhythm with uplifting energy Let the producer choose for me Success Visualization Describe Your Ideal Self in 6 Months: What Would Success Look Like?: Habits to Release or Transform: Additional Information Other Notes: How Did You Hear About This? Social media Referral Google search Professional network Other Package Selection Essence Affirmation ($50) Deliverables: Short script + 30–45 second audioEstimated Delivery: 3 business days Signature Mantra ($150) Deliverables: Full custom script + 1–2 minute professional recordingEstimated Delivery: 5 business days Affirmation Legacy Audio ($300) Deliverables: Extended script + high-quality production (2–4 minutes)Estimated Delivery: 7–10 business days Preferred Delivery Timeline: By submitting this form, you consent to the use of your responses to craft a personalized affirmation experience designed to support your growth, alignment, and empowerment. Submit