Quantum You Program Application
Welcome - whatever brought you to this point in your journey, I see you and celebrate you on this HUGE Step.

I invite you to fill out this application for enrollment in Quantum You:
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First Name: *
Last Name: *
Email address: *
Address: *
Phone Number: *
Date of Birth *
Where are you from? *
Why Now? *
Are you committed to showing up and doing the work physically, consciously, mentally, and energetically? *
If accepted what are you looking to accomplish? *
What are the stories/wounds/pains/patterns that have caused you not to live up to your true potential thus far? *
What is this costing you if you do nothing or stay in the same cycle? *
What would your life look like if you cleared and HEALED those pains? *
Do you deserve, allow, receive, and believe what is coming to you and that it is possible? *
Do you give me permission and consent to work with you? *
Are you willing and committed to invest energy (time and money) in yourself to achieve this? *
On a scale from 1-10, how WILLING and COMMITTED are you to stretch yourself physically, mentally, emotionally, and energetically for the sake of your dreams? *
Why me as your coach/mentor/instigator? *
What is your profession/job/career? *
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