Full Name
Email
*
Which social media platform did we connect on?
Instagram
Facebook
What is your social media handle (so that I can connect with you easier?)
What are your primary health and wellness goals right now? (select all that apply)
Learn more about health and wellness topics
Understand and regulate my nervous system better
Gain a deeper understanding of trauma-informed movement
Improve my stress management skills
Build a personalized wellness plan
Join a supportive community for encouragement and accountability
What best describes your current challenges? (Select all that apply)
Fatigue or lack of energy
Stress or difficulty managing emotions
Chronic pain or physical discomfort
Overwhelm or difficulty with focus
Feeling disconnected or stuck
None of the above; I just want to enhance my overall well-being
Other (Please specify):
How do you prefer to learn about health and wellness? (Select one)
Reading eBooks and self-study materials at my own pace
Attending workshops on specific topics with guided resources
Participating in a comprehensive course with certification
Do you enjoy exploring health topics in a structured, step-by-step program?
Yes, I prefer a structured program with guidance and tools.
No, I like to explore topics independently or in small chunks.
Are you interested in earning a certification in trauma-informed movement?
Yes, I’d like to gain expertise and a certification.
No, I’m just looking for personal growth and wellness tools.
Do you feel you would benefit from personalized, one-on-one coaching?
Yes, I need tailored support and accountability.
No, I’m comfortable with more general guidance.
Do you prefer working within a supportive group or community?
Yes, I enjoy learning and growing alongside others.
No, I prefer to work on my own.
How much structure and guidance do you need in managing stress and creating balance?
High: I’d like clear direction and support from a coach or instructor.
Medium: I like some structure but also value flexibility.
Low: I prefer to explore and experiment at my own pace.
Which ONE of these statements best resonates with you? (at this time)
I’m new to these concepts and would like to start with basic resources (eBooks).
I’d like a mix of learning and community engagement (Learning Lab).
I’m ready for an intensive, transformative journey (Rethink Wellness Academy).
I prefer a self-paced, flexible program (Restoring Balance).
I thrive in collaborative environments with ongoing guidance (Inner Circle).
I’d like one-on-one support to address my specific needs (1:1 Coaching).
We Recommend This To Start Your Healing Journey