Optimal Life Coaching for Teens
Inquiry Form
The best way to get started so you can begin working with your teen coach, is to fill out this form. Denise will be in touch with you to set up your FREE Introduction Session. During this session, we get to meet, discuss your goals, and determine if we are a good fit for each other! I can't wait to meet you and get started.
Name of teenager
First Name
Last Name
Teen's Email Address
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Age
Phone Number of Teenager
Please enter a valid phone number.
Who is the referring party?
Please Select
Self
Teacher
School Counselor
Parent
If you are under the age of 18, please tell me a little about your guardian/parent. What is you parent's name?
Parent/Guardian Phone Number
Please enter a valid phone number.
Email of the parent of the teen referral:
example@example.com
Please check all that apply. I would like coaching in the following areas:
Anxiety
Depression
Social Anxiety
Self-Esteem
Building Confidence
Sleep Disturbances
Mindset
Academic Performance
Career/College
Healthy Habits
Setting Boundaries
Peer Relationships
Communication Skills
Anger Management
LGBTQ+
Other
Is there anything else you would like your coach to know before contacting you to set up the complimentary first session?
Submit
Should be Empty: