Premium Coaching Application
Share your contact details, goals, and current situation to apply for premium coaching.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What's driving you to look at this right now?
*
What are you rebuilding?
*
Recovery
Health
Finances
Marriage/Family
Faith
Career
Other
Have you taken the Real Life Assessment? What was your score?
What have you already tried, and where did it stop working?
Are you currently working with a therapist, doctor, or clinical program?
Yes
No
Which fits your payment preference?
*
$7,500 paid in full
$700/month for 12 months
Anything else I should know before we talk?
I understand this is coaching, not therapy or medical care.
*
I understand and agree
Submit Application
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