1:1 Coaching Application

1

Name:* This field is required.

First Name

Last Name

2

E-mail address:* This field is required.

example@example.com

3

How did you hear about me?* This field is required.

4

Where are you not setting boundaries or not feeling considered by other people in your life? How is this impacting or hurting you?* This field is required.

5

If you and I were to work together and you looked back and said, “I'm so glad I worked with Jay,” what are the top 3 outcomes you would like to have achieved?* This field is required.

6

Please describe your personal growth path. (i.e. Have you worked with coaches or therapists in the past? Do you have any practices you engage in like yoga or meditation?)* This field is required.

7

Do any of these apply to you?* This field is required.

Have an active addiction

Have a history of trauma

Have anxiety and/or depression

None of the Above

8

Are you currently seeing a psychologist or psychiatrist? If so, what are you in treatment for?* This field is required.

9

Provided we are a good fit for each other, when would you like to start working with me?

10

Are you prepared to invest $2,400 USD to shift your relational patterns in the next 2 months, and to have lifetime access to the Yours Truly curriculum?* This field is required.Choose all that apply

Yes

No

I'd be interested in doing a free 30-minute coaching session that will be recorded (either video or audio only) and potentially used on Jay's social media.

I'd be interested in working with one of Jay's associate coaches at a reduced rate.

Please add me to the waitlist for the next round of Jay's signature group coaching program, Yours Truly.

11

Check out how equity pricing works here and then provide just the number of categories you identify with below. For each category you identify with you will receive $100 off the cost of 1:1 coaching.So if you identify with 1 category, that's $100 off, 2 is $200 off, etc.

12

Please tell us how you'd like to proceed.* This field is required.

I'd like to be added to Jay's waitlist

I'd like to book an interview with a Yours Truly Associate Coach