First Name *

Last Name *

Phone *

Email *

What are you currently struggling with? *

What made you interested in The Heart House Method™? *

Have you worked with a coach, counselor, or therapist before? If yes, how long did you work together and how long ago? *

What are you hoping to change or heal? *

Are you looking for 1:1 coaching, group support, or not sure yet? *

How ready are you to begin? *

Now / Within 30 Days / Exploring

Care, Privacy, and Consent *

I understand this is coaching and not therapy or medical treatment.

By checking this box, I consent to receive non-marketing text messages from The Heart House, LLC about appointments, scheduling, support, and next steps. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others.from The Heart House, LLC at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.