What are the most important goals for us to accomplish during our 12 sessions together? (Imagine we are chatting AFTER you've completed the 12 sessions, what had to have happened for you to feel happy about the decision for us to work together?) *

In your opinion, what is standing in the way of accomplishing those goals on your own? *

What does success look like to you? *

Who else is involved in your decision making? *

Have you done any therapy or shadow work in the past? *

Yes

No

Please check what applies to you: What do you value the most when you invest in yourself? *

Quality

Speed

Price

Do you consider yourself an action taker? *

Yes

No

How open are you to putting in consistent time and effort into your healing process *

I have plenty of time to be consistent in action for my transformation.

I can make the time and be consistent in action for my transformation.

I won't put in any time or consistent action for my transformation.

How willing are you to invest in yourself? *

I have the financial resources to invest in myself now.

I can generate the financial resources to invest in myself now.

I have little to no available financial resources to invest in myself now.

First Name & Last Name *

Email *

Phone *

What country do you live in? *

Date of birth *

How did you hear about me? *