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Journey Forward Coaching Application
Are you ready to create the lasting change that you need to be happy, fulfilled and content? Let's see if we are the right fit in working together. I am taking a limited number of coaching clients and want to make sure that you are ready to commit to your Journey Forward! And please note, all information contained herein is confidential.
* Required
Email address
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Your email
Which coaching package are you interested in?
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Signature Session - $299
Introduction - $1149
Implementation - $3399
Integration - $5499
Name
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Your answer
Phone number
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Your answer
City, State
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Your answer
Age
Your answer
Are you...
Married
Single
Divorced
Widow
Do you have children?
Yes
No
Clear selection
If yes, how many?
Your answer
What are the ages of your children?
0-5
6-10
11-15
16+
Do you work?
I stay at home
I work part-time
I work fulltime
I'm retired
Please check the areas in your life in which you are feeling stuck, unhappy or dissatisfied (choose as many as applicable)
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My sense of self (loud inner critic, poor self-concept, self-judgments)
Relationship challenges
Parenting struggles
Extended family stress
Generalized stress / anxiety
Depression
Addiction
I don't know what I want to do with my life (career path)
Poor relationship with my body
Spiritual crisis (not sure what to believe in)
Socially disconnected (few, or poor, friendships; little community)
Political / Global anxiety
Difficulty making decisions
Experiencing major life transition (divorce, relocation, aging, illness...)
Other...
Required
Please expand, if you'd like, on any checked box from above...
Your answer
How long have you felt stuck?
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Your answer
What have you done so far to work towards creating change?
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Your answer
If you have done some work (therapy, self-help, etc...) what has been helpful? And what hasn't been helpful?
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Your answer
Are you ready to release the old stories, limiting beliefs, habits or patterns that are no longer serving you?
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Yes!!!!
No...that feels really hard
I think so, but am a bit hesitant
Do you have a...
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Meditation Practice
Mindfulness Practice
Required
Are you able to commit to weekly 1-hour calls?
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Yes
No
Please share any additional information you'd like me to know in working with you
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Your answer
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