First Name *

Last Name *

Phone *

Email *

What is your primary motivation for committing to powerful lifestyle work, and why is this the right time for you to make this commitment to yourself? *

Describe the biggest obstacle or recurring pattern that has prevented you from achieving your desired romantic life, intimate life, health or success. How have you attempted to address this challenge in the past? *

On a scale of 1-10, how committed are you to making deep, lasting changes in your life? Explain what makes this commitment level true for you. *

This journey will require vulnerability, self-reflection, and openness to new practices. How comfortable are you with delving into this work to foster authentic, lasting change? *

What specific areas of your life do you most want to heal, change and optimise? How would you like these changes to impact your health, relationships, and career? *

How will you measure success throughout the journey? Are there specific transformations or milestones you hope to achieve along the way? *

This program integrates powerful neurological modalities such as Time Line Therapy, NLP, and hypnotherapy. Are you open to these techniques, and do you have any specific experiences with them that you’d like to share? *

What support system do you currently have in place (e.g., friends, family, colleagues) to help you stay committed and grounded throughout this process? *

Are you prepared to invest the time, energy, and focus necessary to ensure each phase of healing is realised? How do you plan to prioritise this journey over the next 18 months? *

By the end of this program, how would you like your life to look and feel? Describe the vision of abundance, health, and freedom that you wish to achieve through this transformation. Really feel it - What do you want most? *

Courtenay’s 1:1 private work is a bespoke, high-investment experience, typically ranging from four to six figures. Flexible payment structures are available, and some may be eligible for tax deductions. Are you currently positioned to invest at this level? (If not, simply state so — alternative pathways are avaialble.) (copy) *

Where did you hear about Courtenay's work? If you were referred, please share their name. *

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