Application for Services

Please complete the form below with as much honesty and detail as possible. All responses are confidential and will only be used to determine coaching readiness.

Full Name

Phone Number

Email Address

Which service are you applying for?

Which describes you best?

New, not serious, only curious. Been trying to make positive changes for a while but I am still struggling. I have been struggling for a while, I feel discouraged, and I am desperate for a solution.

Please describe what you’re struggling with the most right now and how it’s affecting your life?

What are the various programs you have tried in the past that did not really work for you and/or were short-lived?

What do you want to achieve from working with me, what’s the BIG goal or outcome that you are wanting?

Do you have the financial resources to invest in this coaching IF what I have is EXACTLY what you need to finally reach your goals and SUSTAIN them?

Yes, I have money to invest in finding a solution. Yes, I can access money to invest in finding a solution. No, I cannot invest in myself right now.

Finally, where are you on this scale of 1 – 10? (1 = Not serious, 10 = I’ll do WHATEVER it takes)

Is there anything else you feel I should know?