Mentorship Interest Form
Name
*
First Name
Last Name
Email
*
example@example.com
What's bringing you here right now?Not the whole story — just what made today the day you filled this out.
What feels stuck, heavy, or out of alignment in your life?Be as honest as you're able. Nothing here shocks me.
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What have you already tried?Therapy, coaching, courses, healers, protocols — and what did or didn't shift.
What would your life look like six months from now if this worked?Describe it specifically. Not "I'd be happy" — what are you doing, feeling, no longer carrying?
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Is there anything you know you're afraid will come up if you do this work?
On a scale of 1–10, how ready are you to change something about how you're currently living? Then: What makes it that number and not a 10?
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Where do you tend to go when things get uncomfortable — push harder, go quiet, distract, leave?No wrong answer. It just helps me support you well.
What has stopped you from finishing something like this before?
This mentorship is an investment of ($1800-$3300). Are you in a position to invest that in yourself right now?
Please Select
Yes
Yes, with a payment plan
Not yet, but I need to shift soon
What does investing in yourself bring up for you?
*
Submit
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