Coaching – Expression of Interest

Thanks for your interest in working together.

This short form helps me understand where you are and what you’re looking for. Once I’ve reviewed it, I’ll reach out with a scheduling link so we can connect and see if this feels like a good fit for both of us.

Share a little bit about yourself to be informed of future challenges.

First Name *

Last Name *

Phone *

Email *

Which best describes your current situation? *

What prompted you to reach out right now? *

What would you hope is different 6–12 months from now? *

If this feels like a fit, are you willing to invest time and resources in meaningful change? *

Yes

No

Is there anything else you would like me to know before our call? *

Would you like to receive the Rebel Dispatch - our monthly newsletter?

Yes

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