Connection call: Apply for 1:1 Somatic Coaching
This form is to apply for 1:1 coaching with me. Once you've completed the form, please book a connection call with me so we can connect and decide whether this feels right for both of us.
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What is your full name?
What is your email address? Please check your e-mail within 48 hours for a response. We will be in touch
What country do you reside in?
Have you worked with a coach in the past?
Yes, personal coaching
Yes, business coaching
Yes, personal + business coaching
No, I haven't - I'm beginning my journey
No, but I have worked with a therapist/healer
What are the physical or mental issues you are working with right now?
What is your number one challenge right now?
What are three things you hope to accomplish over the next 1 year?
What do you think is standing in the way of what you want? Are you willing to overcome these challenges to step into the life or state of health that you truly desire?
On a scale of 1-10, how committed are you to working through the deeper emotional issues that may hold you back?
I'm not committed yet
I'm 100% ready now
How much time are you willing to invest in yourself by devoting time each day to suggested practices/activities?
5-10 minutes a day
20-30 minutes a day
up to 1 hour a day
Are you open to receiving feedback within coaching sessions?
Thank you for your time - I look forward to connecting with you soon.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Connected Craniosacral.