Revive to Thrive Interest Form

  • Revive to Thrive Interest Form

  • Thank you for your interest in Revive to Thrive.

    Note: All information gathered here is protected, and in compliance with HIPAA and all other state and federal privacy laws.

  • What is Revive to Thrive?

    This program is designed with 18-25 year olds in mind. Your commitment of 4-6 weeks to individualized coaching will help you be on your way to reaching your goals and moving forward in the areas of life that matter most to you. Your coach is ready to get started on helping you craft your goals, create structure and accomplish what you want by holding you accountable and being your cheerleader. Get started today and let us know that you are interested in this journey by completing this form.

  • Part 1: Demographic Information 

    Please complete all fields.
  • Date*
     / /
  • Format: (000) 000-0000.
  • Best method of communication
  • Age*
  • Sex*
  • Are you currently attending school?
  • How did you hear about Beautiful Minds and Revive to Thrive Coaching?*

  • Part 2: Mental Well-Being Support   

  • Have you been seen or treated by a mental health professional in the past year?*
  • Are you currently being seen or treated by a mental health professional?*
  • Have you ever attended group therapy or group coaching?*

  • Part 3: Program Interest

  • Life-long transformation and healthy well-being requires commitment. How interested are you in being part of an 4-6 week engagement that will include 1 on 1 coaching sessions and connecing in person?*
  • If interested, are you able to attend weekly, in-person connection meetings at a fun and engaging location in Placer County?*
  • Which method of 1 on 1 coaching sessions do you prefer?*
  • What is the most significant life or mental health challenge you are facing at this time?*
  • Should be Empty: