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Name
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Age
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How did you find out about me? (If a specific person referred you please list their name here.)
What brings you to apply for coaching with me? Tell me a bit about what is going on.
Which offer are you most interested in?
Tier 1: 3 Month - Biweekly Sessions $2500/month
Tier 2: 3 Month - Weekly Sessions $3k/month
Tier 3: 6 Month - Biweekly Sessions $2k/month
Tier 4: 6 Month - Weekly Sessions $2500/month
Other: My budget doesn't quite align, I would be interested in learning about the membership
What is your budget for coaching support?
What would you like to see happen for your healing in the next 3-6 months? What are your goals? What is stopping you from being there?
What in your life feels like it is working well?
Is there anything in particular you are wanting to learn from me?
Tell me about your healing journey so far. Please include any past therapy or coaching experience.
Are you ready to invest financially, time and energy wise into your healing?
Yes! I'm all in.
Not sure.
Definitely not
Do you have access to stable wifi and device with a camera?
Yes
No
Coaching packages start at $2000 per month. Are you ready to make this level of investment?
Yes
No
Unsure
Will you show up for your FREE discovery call with me?
Hell yeah I'll be there, can't wait!
No, I don't like free things
Anything else you think I should know?
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