One-On-One Freedom Coaching
Please fill out the form to help Michelle discover how to best support you. Please TAKE YOUR TIME to answer as honestly and with as much detail as possible. This information will remain strictly confidential.
Name
*
First Name
Last Name
E-mail
*
Phone Number
-
Area Code
Phone Number
How long have you struggled with the issue you're wanting support with?
1-3 years
5-10 years
Most of my life
Have you hired a coach before? If so, who?
Life Coach
Talk Therapy
Hypnosis
Other emotional release work
If you've tried other emotional release work, what was it?
What is your biggest challenge when it comes to change in your life?
What are the things you say to yourself or feel most of the day?
What will happen in your life if nothing changes AND will that be okay with you?
What is the biggest benefit you're looking to get out of working with Michelle?
How serious are you about creating change?
4: VERY Committed! I'm serious and Ready To GO!
3: Starting to feel committed
2: kind of committed
1: Not committed at all
Is there anything else you want Michelle to know when reviewing your application?
How did you hear about us?
Internet search
Facebook
I've been on your email list for a while
A friend (please write who in the next box)
I don't remember
If someone told you about us, who can we thank for helping us spread the word? =) Thank you!
Submit Application
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