Welcome

1

Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Area Code

Phone Number

4

Please share days/times that work best for your schedule.

5

What form of communication do you prefer to have a listening session in?

Phone

Zoom

6

To your comfort level share a bit about you and what you are struggling with.

7

My rate is $64 per 30 minutes of empathetic listening time. Do you agree with this rate? You will be invoiced for my time prior to our session.

YESNO

8

Please verify that you are human* This field is required.