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VIP Consult
These questions will support you and I in looking at your life from a new perspective and at the same time they will help me to get to know you better.  Please allow yourself uninterrupted time to complete this form and be as open and honest as you can. 

Please answer the questions with as much detail as possible. Short one sentence answers will disqualify applications.

Email address *
First & Last Name *
Your answer
Best Number to Reach You At *
Your answer
LinkedIn Profile
Your answer
What are you struggling with the most right now? *
Your answer
Why are you serious about changing this in your life right now? *
Your answer
Are you taking any psychological medications or currently seeing a therapist? (Please be specific.) *
Your answer
If we were to work together what outcome would make you happy? *
Your answer
Which one best describes you right now? *
A copy of your responses will be emailed to the address you provided.
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