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In order to make good use of your time, please take a few minutes to complete this simple application to clarify what’s holding you back, specifically. Then, tell me the best times of day to contact you about setting up a consultation with you.
8
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1
How did you first find me?
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Google
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Website
Psycholoty Today
GAYLESTA
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2
Which of the following best describes your current relationship status?
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Please tell me a little bit about yourself, so that I can better understand your situation
Single
Dating / Long Term Relationship / Engaged
Married
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3
The challenges you face at age 18 aren't the same as those you'll face at 68. To help me understand what you would most benefit from, which of the following best describes your age?
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20's
30's
40's
50's
60's
70's and older
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4
Can you tell me about yourself, and what's making you look for guidance at this time?
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Please be as detailed and specific as possible
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5
Thank you! Since I only have a limited number of spots available to work with new clients, what are you looking to achieve as we work together?
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Again, please be as detailed and specific as possible. What’s your vision or dream here? What would you define “success” as?
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6
And as I mentioned, spots are limited, only because there's only so much space available in my schedule. Why should I consider accepting you for one of those spots?
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Tell me what makes your readiness for this work unique or apparent...
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7
Working with me usually requires an investment of at least $2,000. Have you made the funds available to make this investment right now?
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Yes
No
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8
Not Finished Yet... Last (And Most Important) Step! Please Confirm Your Contact Information Below, And Then Tell Me The Best Times To Contact You
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I will contact you within 48 hours after you submit this form.
Please enter your name
Please enter your email
Please enter your phone number
Please tell the best times of day to contact you
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