ONE-ON-ONE SESSIONS: NERVOUS SYSTEM SUPPORT FOR YOU AND YOUR BUSINESS

APPLICATION FORM

welcome!

I’m so happy you’ve landed here.

Please complete this confidential form that will help us both get a sense of whether this work is the best fit for you. Once I receive your application, I’ll respond within a few business days. If it seems like a good fit, we’ll find a time to chat via zoom or phone to connect and keep exploring the possibility of working together.

Looking forward to it!

NAME

First Name

Last Name

PRONOUNS

I doubled checked my email and it's correct

PHONE

Please include country code

Country

(###)

###

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Where did you find me and what made you decide to fill this out?

Describe your current situation in business. Specifically, please include your business model (i.e. how you serve your clients/offers), income level (no stress here at all, but just gives me an idea of our starting point), current focus (i.e. what you're working on right now), and anything else you feel is important for me to know.

In the next year what would you love to have happen in your life regarding professional healing and growth?

What does success look like and feel like for you? How will you know when you're experiencing it?

What inspires you to be supported by me, specifically?

Sessions are generally the first 3 weeks of every month, are you available for this?

Have you experienced therapy, coaching or other personal or professional development support before? Tell me a little about it and how it went. What worked and what didn't work?

Sessions can be a significant investment in your time, money and energy and it’s important this process can be sustainable for you. If we decide to work together, are you available to fully commit to this process? (From $1000 monthly).

Yes

What additional information do you feel is important for me to know?

Tell me about what you're really proud of in your life and business!

What support and resources do you have in your life that will help you be able to fully sink into this process?

YOUR WEBSITE AND SOCIALS