Psychotherapy Informed Coaching

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Private Application

This application is your first step into a high-level, deeply personalized experience.

Please take your time and answer each question with as much honesty and detail as possible. Your responses help me understand where you are, what you’re navigating, and how I can best support you, even before we speak.

The more you share, the more precise and impactful our work together can be.

I read every word personally. Let’s begin.

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Name* This field is required.

First Name

Last Name

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Email* This field is required.

example@example.com

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Phone Number* This field is required.

Please enter a valid phone number.

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

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What time zone are you in (for scheduling purposes)?* This field is required.

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What is currently not working in your life and/or marriage?* This field is required.

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What have you tried to address this? (Therapy, talking, books, podcasts, etc)* This field is required.

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What is your main goal for seeking help at this time? What would you like to accomplish in the work with me?* This field is required.

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This is a high-level, concierge-style container that requires deep commitment, presence, and follow-through. Are you ready to fully show up for this work?* This field is required.

Yes I am.

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If you are coming for marriage coaching, please note that you both must be present for the initial consult.* This field is required.

Yes we will both be there

I'm interested in 1:1 for just me.

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Are you willing and able to dedicate time on a weekly basis to have meetings with me and/or do the work in between our calls?* This field is required.

Yes! We (or I) are ready to start the work now and acknowledge that this is a commitment requiring our time, energy and focus.

I don't know if we (or I) have the space available for this right now.

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Is there anything else that would be helpful for me to know prior to our call?* This field is required.

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Thank you for completing your application.
I deeply value the time, thought, and honesty you’ve brought to this process.

Over the next 24–48 hours, I’ll personally review your responses and be in touch regarding next steps.

Warmly,
Carrie