Coaching Application

Full Name *

First Name

Last Name

Email Address *

Phone Number *

Phone Number

What is drawing you to this coaching work at this time in your life? *

What specific challenges are you currently facing in your healing journey? *

(Emotional, mental, physical, spiritual, relational, etc.)

On a sacle of 1-10, how ready are you to commit to deep, transformative work? *

1 2 3 4 5 6 7 8 9 10

Have you worked with a coach, therapist, or healer before? *

If so, what was your experience?

What are you hoping to gain or shift through this process? *

Are you willing to challenge and shift old belief systems that may be holding you back? *

Are you open to exploring somatic work, energy healing, breathwork, and mindset shifts? *

What resistance (if any) do you feel when thinking about doing this work? *

How do you typically respond when faced with emotional discomfort or triggers? *

How do you handle personal accountability and self-refelction? *

Are you able to dedicate time to daily or weekly practices outside of our sessions? *

Do you have a strong support system, or are you willing to build one? *

Why do you believe now is the right time for you to do this work? *

Is there anything else you'd like to share that would help determine if this is the right fit for you? *

Which coaching structure are you most interested in?

Are you prepared to make a financial investment in yourself at this time?

Would you prefer to pay in full (with discount) or use a payment plan?