Come to Rise Application

Come to Rise Application

**PLEASE READ**How this works: #1.Complete assessment to let me know where you stand. #2. I will email you within 2 business days to schedule a discovery call. #3. We will meet by zoom for 30 minutes.
What is your first & last name?*
What is your best email?*
What is your time zone?*
What is your phone number? (This will be used for meeting/call text reminders)*
Have you been involved in an abusive relationship*

YesNoNot sure
Do you think your partner is (or could be) a narcissist?*

YesNoNot sure
What makes you believe he is or could be a narcissist? Express yourself below.*
How long ago did you break up?*
What is your biggest struggle right now?*

No self-loveI don't even know myselfI still miss himI feel lost and brokenI'm so confusedOther
Add details here...*
On a scale of 1-5, how would you describe how you feel on a daily basis?*
What do you think are the factors for feeling like this right now?*
If you woke up tomorrow and had to start over completely, what would you do? (ex: start a business, move to another state...)*
What's missing from my life is a sense of ______________.*
Have you worked with a coach in the past? If so, what was that experience like for you?*
Are you working with a coach now?*

YesNo
Do you have any questions you'd like for me to go over with you? *
What have you been experiencing that has made you take this step?*
Would you like to subscribe to my email list for resources, podcast updates, etc.

YesNo
Should be Empty: