Battered Hearts Rising Coaching Program Application

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Welcome, Battered Heart.

This application is the first step in reclaiming your healing journey. Please fill out the questions below so we can ensure the Battered Hearts Rising Coaching Program is the right fit for your needs.

Email *

Full Name *

Email Address *

What has led you to seek coaching at this point in your journey?

Which areas do you feel most need support? (Select all that apply

Mental Clarity

Emotional Healing

Setting Boundaries

Breaking Trauma Bonds

Building Self-Love

Rebuilding Self-Love

Rebuilding Confidence

Other:

Required

Which phase do you most resonate with right now?

Ethereal Awakening (Mind): Recognizing patterns and gaining clarity

Phoenix Rising (Body): Rebuilding habits, reconnecting to self

Heart Vision (Soul): Building aligned relationships

What would a successful transformation look like for you after these 6 weeks?

Have you worked with a coach before? (Yes/No — if yes, what was your experience?)

Are you able to commit to 2 one-hour sessions per week for 6 weeks?

Yes

How do you prefer to communicate between sessions?

Text

Both

Are you ready to invest your time and resources into breaking free from emotional wounds?

Yes, I am ready and able

I’m ready but would like to discuss payment options

I’m not sure yet

What is one word that describes how you want to feel at the end of this program?

A copy of your responses will be emailed to the address you provided.

Submit

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