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12-Week Coaching Program
Application Form
First name
*
Last name
*
Email
*
Phone
*
What start date would you be ready to begin the 12-week coaching program?
Month
Month
Day
Year
Time Zone
*
What prompted you to apply for coaching at this time?
*
What feels most unclear, heavy, or misaligned in your life right now?
*
What have you already tried to address this? What helped, and what didn’t?
*
When you feel stuck or uncertain, how do you typically respond?
*
I overthink and delay decisions
I push through and ignore it
I take time to think things through
I seek reassurance from others
I avoid the issue altogether
Other
Coaching is a reflective, collaborative process that requires honesty and consistency. What about this approach feels supportive to you?
*
What are you hoping to gain from committing to a 12-week reflective coaching process at this time?
*
The investment for the 12-week private coaching container is $1,200.00 USD and limited to clients in the US. If we mutually decide this is a fit, are you comfortable moving forward at this level of investment?
*
Yes
I'd like to discuss logistics further before deciding.
No
Is there anything else you’d like me to know as I review your application?
Apply
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