Full Name *

Country *

Email *

Phone *

Instagram *

What is your current relationship status? *

Actively dating or early in a new connection

In a committed relationship or marriage

Going through a breakup, separation or divorce

On a break from dating or relationships

What best describes your current challenges? Check all that apply. *

Repeating frustrating patterns in dating or my current relationship

Processing a divorce, break up or pain from past relationships

Attachment patterns: anxiousness, avoidance, or difficulty trusting

Over-functioning, over-giving, or struggling with codependency

Emotional shut down — disconnection, withdraw or numbing

Emotional overwhelm — reactivity, anxiety or difficulty regulating

Difficulty with vulnerability, expressing needs, or letting people in

Desiring deeper, more fulfilling connection and not sure how to get there

Other. Explain below.

Please add any related context to best understand your specific challenges. *

What does success look like to you? What’s your #1 goal? *

Have you had coaching or therapy to address these challenges before? *

Yes — it helped, but I'm ready to go deeper

Yes — but I didn't find it effective or it didn't address the root

No — this would be my first time working on this

No — but I've done significant self-guided work (books, courses, retreats)

Private coaching is an investment in your growth. If we offer a path forward to meet your goals, how ready are you to commit the time, energy and resources to make it happen? *

I’m ready to move forward now if it’s a fit

I’ll be ready in the next 30 days

No, I am not ready