Returning to Self Mentorship Application Form

Returning to Self Mentorship Application Form

Rebuilding emotional steadiness during life's uncertain seasons
Thank you for taking this step. It takes courage to reach out and the fact that you are here tells me something important about where you are and what you are ready for. Please answer each question as honestly as you can. There are no right or wrong answers, only your truth. I look forward to reading your responses and connecting with you personally.

— Justin
This mentorship is for individuals navigating significant life uncertainty who feel ready to slow down, reconnect with themselves and rebuild emotional steadiness from the inside out. This is not about fixing who you are. It is about returning to who you have always been
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
This mentorship requires honesty, consistency and a willingness to engage with your internal growth over time
About Your Journey
Have you read Metamorphosis: A Cancer Journey Through The Mystery of Life or followed Justin's journey in any way?
Are you currently working with a medical, psychological or therapeutic professional?
Where are you currently in your journey?
What has your diagnosis or treatment experience been like emotionally?
Where do you currently feel the most instability - fear, anger, identity shifts, uncertainty?
How has illness impacted your sense of identity or future?
If you where emotionally steady again, what would feel different in your life?
On a scale of 1-10, how committed are you to stabilising emotionally and doing the internal work required?

1

2

3

4

5

6

7

8

9

10

1 is Not yet ready, 10 is Completely committed
Are you prepared to invest in a structured 8-week mentorship container if we both determine it's the right fit?
I understand this mentorship provides emotional support and personal guidance and does not replace medical or psychological care. I will continue working with my licensed healthcare providers where appropriate.
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Returning to Self Mentorship Application Form

About Your Journey