Coaching Application form

1

What’s your email? * This field is required.(required)

example@example.com

2

Have you worked with a coach, therapist, or healer before?* This field is required.(No follow-up explanation needed.)

YESNO

3

Which statement describes you most accurately right now?(select one)

I understand myself well, but I still react in ways I don’t choose

I know what I “should” do, but something keeps hijacking my behavior

I’ve done a lot of inner work, but authority collapses under pressure

I’m tired of insight without real behavioral change

follow through or stay consistent

None of these

4

When you gain insight about yourself, what usually happens next?(select one)

I feel relief, but nothing really changes

I understand the pattern, then repeat it anyway

I intellectualize it and move on

I apply it and see real behavioral change

I’m not sure

5

What are you hoping this conversation will give you?(select one)

I feel relief, but nothing really changes

I understand the pattern, then repeat it anyway

I intellectualize it and move on

I apply it and see real behavioral change

I’m not sure

6

What are you hoping this conversation will give you?(short answer)

7

Important — please read carefully. * This field is required.

YESNO

8

Anything relevant you want me to know before we speak?(optional, long text)