Application Form- Women's Transformational Group
Hello Beautiful Woman!

We are thrilled you're taking action in your life and exploring the possibility of us working together through our Women's Transformational Group.

To be considered for this group, please be sure to fill out this form with complete answers to questions. This helps us determine how we can help you and if we’ll be a good match.

We only have a few openings for this type of group, so please don’t delay submitting your application!

If you’re ready to save yourself years on a therapist’s couch over analyzing past relationships, and work with mentors with over 40 years experience combined, with high success rates for transforming women's lives- then let's connect, and join our group!

Go ahead and fill out your application today and we will be in touch with all the details. Your application is 100% CONFIDENTIAL and will only be read by us personally.

We look forward to connecting with you!


Email address *
Full Name *
Cell Phone *
Date of Birth *
What kind of job do you do (including stay at home mom). Please describe. *
Relationship Status *
1 point
If you are in a relationship, how long have you been together? *
1 point
Do you have any children? *
Required
If you have children: a) How many b) How old are they c) Where do they live? *
What is currently the ONE challenge you are facing in your life? Be as specific as possible: *
What are your personal goals in the next 6-12 months? *
In your heart of hearts are you willing to do whatever it takes to reach the goals you mentioned? *
Aligning with your life goals and vision is not a quick fix. It’s about learning a new way to be along your path, so it requires commitment, consistency and investment.On a scale of 1 to 10, how ready are you to make the changes needed to thrive in your life/love life/parenting? *
On a scale of 1 to 10, how dissatisfied are you with your current life/love life/parenting and how motivated are you to change it (1 = very satisfied and 10 = very dissatisfied)? *
Have your worked with a mentor/coach or a therapist in the past? If yes for how long and did you like the results. *
If so, what would they tell me about how you showed up in that relationship? *
What do you consider is going well in your life? *
What are your strengths as a woman? *
What are your limitations? *
What do you expect from the group? *
Are you currently seeing a therapist or counsellor and if so, for what issues? *
If you are seeing a therapist in a Community Agency in Ottawa, please indicate what agency? *
This group focuses on transforming your life. Shifting from a negative to positive mindset, taking better care of yourself, shifting priorities and relationships. Are you committed to moving forward? *
Are there any barriers to you commiting to a group of this nature? *
Is there anything else you would like us to know about you? *
How did you hear about our program? *
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