1-On-1 Charismedx Coaching Application

Full Name*

First NameLast Name
Cell Number*
Email*
example@example.com
How did you hear about my coaching?*
Please give me a brief summary of your business and/or professional situation*
Please list your social media accounts (if applicable):
Instagram
Facebook
Tik Tok
Other
What professional challenges do you currently face?*
What personal challenges do you currently face?*
Specifically, what are you hoping to gain from coaching with me?*
Please understand this: I offer coaching, and consultation. I am not a trained counselor, psychologist, or mental health professional; nor can I refer you to one. If you have clinical issues, you will have to look elsewhere for help. Do you understand?*

Yes, I understand completely
Currently, the cost for my monthly coaching is $1577/month and the cost for a single strategy session is $450.00. No payment will be due until the first meeting is complete. Also, you and I both have full lives; and my schedule is constantly changing. I don't prefer to use Calendly or a booking app. Once you submit this application, I will reach out personally to find a good date/time that works for both of us. This may take up to 48-72 hours. Do you understand?

Yes, I understand completely
Should be Empty:

Please list your social media accounts (if applicable):