Name
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First Name
Last Name
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Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Instagram Handle
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What intrigued you to apply?
What do you struggle with currently in your relationships?
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Setting & enforcing boundaries
Inconsistency
Control
Unable to get over your ex
Always putting more effort into your relationships
Feeling unfulfilled/exhausted
Feeling insecurity and/or not trusting
Other
Please give me a brief history of your relationships - it could be your past romantic relationships, how your family was growing up, your friendships, etc.
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If I helped you achieve one thing in the next 90 days, what would it be?
When you visualize yourself with clear & magnetic energy - who is this person, and what does this feel like to you? Be as specific as possible!
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Are you only interested in 1:1, or are you open to group-style healing as well?
Only 1:1
I'm open to group work
Are you willing to invest financially into this work?
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Yes
No
If yes, my 1:1 work starts at $2,500/month. Note this isn't just sessions, it complete energetic upgrades and deep identity-resetting work. Are you prepared to make that level of investment? (If not, it is ok, I simply want to direct you in the best direction!)
Yes
I am more likely to invest in very transformative group work (starting at $250/month)
I want to explore some smaller sessions
Do you have any questions for me?
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