Coaching Application

Coaching Application

Welcome! Below are some questions to see if we are the right fit for each other. All answers are completely confidential. Please answer to the best of your ability and I will get back to you within 24 hours (weekdays)
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Date Of Birth*
Instagram Handle*
What is your current relationship status?*

SingleDatingSituationshipRelationship
What is calling you into this work right now? (What was the moment, pattern, or feeling that made you say “I’m ready”?)
How do you currently experience love, dating, intimacy, or relationships? (Be honest — what’s working, what isn’t?)*
What patterns do you feel stuck in*
What feels the hardest or most painful for you right now when it comes to love, self-worth, or relationships?*
What do you deeply desire to experience in love, intimacy, relationships & life?*
How connected do you feel to your body?*

Not at allSomewhatVery connectedI'm not sure
How would you describe your current relationship with your sexuality and sensuality?*
What would make this journey feel successful for you? (Breakthroughs, changes, internal shifts, external shifts — anything.)*
Do you experience any mental health conditions? If so please list below*
Have you experienced any personal or spiritual growth work, therapy or coaching before? If yes, what was that experience like for you?*
Is there anything else you would like me to know to better understand your needs and intentions?*
There is a financial, time & energy investment for this program- are you in the position to make that investment into yourself?*

YesNo
If you are accepted into this program, which payment option works best for you?*

Pay in full3 month payment PlanExtended Payment Plan
Which best describes you?*

I'm so ready for this, sign me upI'm feeling a YES but I have some questions and would love to jump on a 20 minute callI'm not ready to make this kind of commitment
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