1:1 Coaching Application
Thank you for your interest in 1:1 coaching. This application helps me understand what kind of support you are looking for, whether we may be a strong fit, and whether your goals are recovery-related, identity/relationship-related, or personal growth-focused. This is not therapy, crisis support, or a substitute for clinical treatment. If you are currently in crisis, experiencing active suicidal thoughts, or need immediate clinical support, please contact 988, your local emergency services, or go to your nearest ER. 1:1 coaching may be a fit if you are ready for honest reflection, emotional accountability, nervous system awareness, identity rebuilding, relational growth, recovery support, or sober-curious/recovery-adjacent work.
Basic Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram Handle
Where are you located?
*
What is your age?
*
What Kind of Support Are You Seeking?
What type of 1:1 coaching are you primarily interested in?
*
Recovery-related coaching
Relationship/attachment/betrayal recovery support
Identity rebuilding/personal growth
Nervous system/emotional regulation support
Life transition/divorce/rebuilding support
Not sure yet
Other
Is your interest in coaching related to substance use, alcohol, sobriety, recovery, or changing your relationship with a behavior or pattern?
*
Yes
No
Somewhat
I’m not sure
If yes or somewhat, please share briefly what feels relevant.
Which best describes where you are right now?
*
I am sober/in recovery and want additional support
I am sober-curious
I am trying to reduce or stop a substance or behavior
I am in 12-step or another recovery program
I want recovery support but do not fully connect with traditional recovery spaces
I am supporting a loved one in addiction or recovery
This is not recovery-related
Other
Are you currently working with a therapist, sponsor, psychiatrist, treatment team, or other support person?
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Yes
No
Not currently, but I have in the past
Prefer not to say
Your Current Season
What made you reach out now?
*
What are the main patterns or struggles you want support with?
*
Emotional regulation
Relationship patterns
Boundaries
Self-abandonment/people-pleasing
Betrayal/divorce/healing after loss
Shame/self-worth
Recovery/sobriety support
Trauma patterns
Anxiety/overthinking
Rebuilding identity
Discipline/structure
Confidence/visibility
Dating/relationship readiness
Other
What have you already tried?
What keeps not changing, even though you know it needs to?
What would feel different in your life 3 months from now if coaching worked?
Readiness + Fit
How ready are you to be challenged honestly and supported directly?
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Not ready
1
2
3
4
5
6
7
8
9
Very ready
10
1 is Not ready, 10 is Very ready
How willing are you to take action between sessions?
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Not willing
1
2
3
4
5
6
7
8
9
Very willing
10
1 is Not willing, 10 is Very willing
What kind of support do you respond best to?
*
Gentle reflection
Direct feedback
Structure and accountability
Emotional processing
Practical action steps
Nervous system tools
Spiritual/meaning-based reflection
A mix of all of the above
What kind of support does not work well for you?
Are you currently in crisis or needing immediate mental health support?
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No
Yes
I’m not sure
Have you had recent thoughts of harming yourself or someone else? If yes, coaching may not be the appropriate level of support right now. Please contact 988, emergency services, or a licensed clinical provider for immediate support.
*
No
Yes
Prefer to discuss privately
Logistics
Which 1:1 option are you most interested in?
*
Single clarity session
Ongoing monthly coaching
Recovery-related support
Relationship/identity rebuilding support
Not sure yet
What is your general availability for Zoom/video sessions?
*
Are you comfortable meeting by Zoom/video?
*
Yes
No
I prefer to discuss options
Are you open to voice/text support between sessions if included in the coaching container?
Yes
No
Maybe
Are you prepared to make a financial investment in private coaching at this time?
*
Yes
I need pricing details first
I may need a payment plan
Not sure
Final Questions
Why do you feel drawn to working with me specifically?
*
Is there anything you want me to know before reviewing your application?
Submit
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