Information Request Form

1

Name* This field is required.

First Name

Last Name

2

E-mail* This field is required.

example@example.com

3

1. What are you currently struggling with the most in your inner world or daily life?* This field is required.

Overthinking

Harsh Self-Talk

Emotional Overwhelm

Confidence at Work

Something else

Other

4

2. If this issue were lighter or resolved, what would change for you?

5

3. What kind of support feels most helpful to you right now?

A space to think things through

Practical tools and structure

Accountability

I'm not sure

Something else

Other

6

4. If we worked together across 3 focused 1-hour sessions to help you gain clarity and move forward with what you’re dealing with, would you be open to investing $120 in that support?* This field is required.3 x coaching sessions | 1-hour long each

Yes, I would

Not right now

Other