Therapist Personal Brand Form
Answer questions about your brand, online challenges, goals, readiness, and investment so we can assess fit for your personal brand course.
Full Name
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First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Professional Title
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Area of Specialization (e.g., Licensed Professional Counselor specializing in anxiety and trauma)
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Please list your current social media handles (links or usernames) for any professional platforms you use (Instagram, TikTok, Facebook, LinkedIn, etc.)
What is the current state of your personal brand?
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I have not started building my personal brand yet
I have social media accounts but rarely post
I post occasionally but don't have a clear strategy
I post consistently but I'm not seeing the growth I want
I have an established brand but want to grow and monetize it
What has prevented you from fully building your personal brand? Please specify the reasons.
What challenges do you face when showing up online? (Select all that apply)
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Fear of being on camera
Fear of judgment or criticism
Concern about jeopardizing my professional license
Unsure what I can and cannot say online as a therapist
Self-sabotage or overthinking
Lack of confidence
Lack of time
Inconsistency
I don't know what content to create
I don't understand social media or marketing
I haven't identified my niche or ideal audience
Other
If you could overcome these obstacles, what would you ultimately like your personal brand to help you accomplish? (e.g., attract more private-pay clients, become known in your specialty, grow your practice, create additional income streams, launch digital products, workshops, speaking opportunities, etc.)
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What do you believe you need the most help with when developing your personal brand? (e.g., niche, messaging, content creation, video confidence, consistency, social media strategy, monetization, or something else)
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What is your commitment level over the next 3 months?
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I'm ready to start now and willing to put in the work
I'm interested, but I know I'll need accountability
I'm still unsure about showing up online
I'm mainly exploring my options right now
If provided the strategy, education, tools, and support to confidently build your personal brand, what is your realistic investment level?
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Under $500
$500–$1,000
$1,000–$2,500
$2,500–$4,500
$4,500+
I'm not currently in a position to invest
How important is building your personal brand to you right now, and when are you ready to get started: today, tomorrow, or next week?
Why is growing your personal brand important to you right now? What would change personally or professionally if you successfully built the brand you envision?
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