Pre-Qualifying Questionnaire
Please answer the questions thoroughly and you must answer each question. Thank you.
Email address *
First/Last Name *
Telephone Number *
Are you in crisis? If "yes", answer next 2 questions. If not SKIP next 2 questions. *
Are you in physical danger? If "yes", call 911.
Clear selection
What is the nature of your crisis? *
Briefly and thoroughly describe what led you to reach out to me. *
What is your anxiety level around what caused you to reach out to me? *
Do you have a hope for how it all turns out or an "ideal resolution" you're hoping for, and if so what is it? *
Have you tried other things (therapy/coaching) to resolve this issue? If so, what? What were the results? *
Are you willing to have your beliefs challenged to help bring about the mindset transformations needed for a self-loving and healthy positive outcome? *
What else do you want me to know about you? *
Should we move to a phone conversation in order to register you for my LIFE course, you'll need to click "I understand" below indicating your agreement to this statement: I understand that the call is being recorded and that it is confidential. *
I am not in the business of convincing to convert. You know if you're ready to transform those painful places to peace and you know if you resonate with me as the one to guide you through -- and in that case this is about to be the best ride of your life and I GOT you. To that end, the investment for the LIFE Course that will have you feeling better about yourself than ever, that will fill in your personal growth gaps and set you up for the life you were designed to live in just 8 Weeks with direct weekly support from me is $5300, and the value is priceless. The following is true about you: *
Where did you hear about me?
A copy of your responses will be emailed to the address you provided.
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