Sobriety Coaching Form

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Have you previously sought sobriety coaching or treatment?* This field is required.

YESNO

5

If yes, please briefly describe your previous experience:

6

Are there any specific goals or challenges related to sobriety that you would like to work on with a coach?

7

Describe what success would look like for you.

8

Do you have a support system in place (family, friends, support groups) for your sobriety journey?* This field is required.

YESNO

9

Are you comfortable with the expense of sobriety coaching?* This field is required.1:1 Coaching programs start at $697/mo (Programs are available for 3, 6 and 12 months) .

YESNO

10

I am not a licensed medical professional, therapist, or counselor. My role as a life coach is to provide personalized support and guidance to individuals on their journey. I do not offer medical or psychiatric advice. Please consult with qualified healthcare or mental health professionals for any medical or psychological concerns.