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Mother-Daughter Questionnaire

Enough is enough!!...When is she ever going to learn?!...I’m so sick and tired of...Are you at the end of your rope and wishing that your relationship with your mother or daughter was different? Do things need to change now, or else? Now is your chance to set aside your differences and get through to your mother or daughter, NO MATTER WHAT!

Bestselling author and motivational speaker, Lisa Nichols, has moved mountains for millions by helping others bounce back from obstacles and move forward on a path towards happiness, courage and strength. Now, it’s your turn!

Allow Lisa to bring her talents, motivation, and NO MATTER WHAT action plan to help mend your mother/daughter relationship. Please share your story and explain why you need Lisa Nichols’ help.

For TV purposes we do need some additional information from you. Please review the information we are requesting below and simply reply to this email: LisaNicholsProject@gmail.com.


PART ONE (Basic Information):

Name:
Address:
Telephone # to best reach you on:
Age/Date of Birth:
PHOTOS:

1. Please submit a recent photo(s) of you and your mother.
2. We also welcome photos of you with your family and friends. Please specify who are in the photos.

PART TWO:
Tell us something about you and your life, for example:


1. Are you single, married, or divorced? If so, name of spouse/significant other?
2. Do you have children? If so, please list name and ages.
3. Are you currently employed? If so, what is your occupation?
4. What are your hobbies and interests?
5. Have you seen Lisa Nichols at prior speaking engagements? If so, where and what kind of impact did she have on you?

PART THREE:
GETTING TO KNOW YOU (Please answer every question. Do not leave any questions unanswered or any space blank. If a question is not applicable to you, write N/A in the space provided, or, if no space is provided, next to the question.)


How would you describe yourself in one word?
How might someone else describe you in one word?
How would you describe your Mother/Daughter in one word?
How might your Daughter/Mother describe you in one word?
What would someone close to you describe as your best and worst traits?
What would your Mother/Daughter describe as your best and worst traits?
What is the biggest misconception others sometimes have about you?
What is it that your Daughter/Mother can't seem to understand about you?
What are you like in a social setting? How do you think you affect group dynamics?
Describe your most embarrassing moment.. . (And/or describe what you wish were your most embarrassing moment.)
What is an odd fact about you or unusual talent you possess?
What makes you nervous?
What are your favorite books, magazines, TV shows, movies, plays?

PART FOUR:
Please address the following questions in regards to your relationship with your mother/daughter....just open up your mind and heart to us so we can feel and hear those thoughts and emotions.


1. How would you best describe your relationship with your mother/daughter? How often do you see/speak to one another?
2. Has your relationship with your mother/daughter changed over the years? Please specify how it has changed.
3. What are some of the issues, conflicts and concerns that you have with your mother/daughter?
4. Do you feel like your mother/daughter is supportive of you and the decisions that you make?
5. What do you wish that you could change about your relationship with your mother/daughter?
6. If you could say one thing to your mother/daughter, what would it be?
7. Has your relationship with your mother/daughter had an affect on your personal life, home, relationships, career, etc.? Please be specific.
8. How do you work through your disagreements? Do you tend to confront one another or harbor thoughts and/or feelings? Please be specific.
9. Please state in detail your motivation for seeking guidance from Lisa at this time. What, if any, has been the turning point?
10. Please explain why this experience would be important to you.

PART FIVE:
Sharing your story for TV


1. If your story is selected, for TV purposes what family members/ friends will be involved? (Please list name, age, and relationship) We encourage family members and friends close to you to be involved and help support you during this process.
2. All potential guests are asked to sign a RELEASE which gives us permission to use 'film'/taped interviews, photos, etc on our show and for PR Purposes. Is this acceptable to you?

Again, thank you for sharing your story. Please understand that we are receiving thousands of requests BUT the fact that you are receiving this should be encouraging. We are indeed interested in learning more about your story. We wish you nothing but joy and hope as you begin this journey.
 

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9:30 pm
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11:00 pm
 
11:30 pm
 
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