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 willing to invest financially into this work?
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Yes
No
If yes, what is your intentioned investment?
Deep, longer, lasting internal work ($6,899 PIF or $1,000-1,500/month)
Deep, focused work ($4,799 PIF or $800/month)
Less personalized, yet deeply transformative, healing body work (~$555/month)
Lighter, yet consistent work (~$111/month)
Do you have any questions for me?
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