First Name *

Last Name *

Email *

Phone *

In a few words your intention for reaching out? *

Referred By

What specific area(s) are you seeking support with?*

Self-doubt, self-sabotage, and/or imposter syndrome.

Creating and executing long-term strategies to achieve business/professional goals.

Building and maintaining meaningful connections with others.

Managing and regulating emotions such as anxiety, depression, anger or fear.

Other

If "Other", please specify below.

How are these struggles impacting your career and/or your daily life? *

What is your current monthly income?

What results do you want to achieve in the next 6 months? *

What will life be like when you are finally free to create the life you want? How will you feel? *

On a scale of 0 to 10 -“Whatever it takes!”, how committed are you to achieving the results you listed above? *

What do you want to create during our time together? *

Is there anything else we need to know to prepare for our call?