Journey Forward Coaching Application

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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.

Email *

Name *

Phone number *

City, State *

Age

Are you...

Single

Married

Separated

Divorced

Widow

Do you have children?

Yes

Clear selection

If yes, how many?

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) *

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...)

Health / overall wellness

Fixed mindset - I don't believe change is possible (or I don't think I can do it)

Required

Please expand, if you'd like, on any checked box from above...

How long have you felt stuck? *

What have you done so far to work towards creating change? *

If you have done some work (therapy, self-help, etc...) what has been helpful? And what hasn't been helpful? *

Are you ready to release the old stories, limiting beliefs, habits or patterns that are no longer serving you? *

Yes!!!!

No...that feels really hard

I think so, but am a bit hesitant

Do you have a... *

Meditation Practice

Mindfulness Practice

Journaling Practice

Required

Are you able to commit to weekly 1-hour calls? *

Yes

Please share any additional information you'd like me to know in working with you *

Which coaching package are you interested in? *

Introduction - $1499 - 4 sessions

Implementation - $4299 - 12 sessions

Integration - $6999 - 20 sessions

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