1:1 Application
Thank you for your interest in working together. I take your desire for transformation really seriously! 

Please take your time and fully answer the questions, the more you share, the more value you will get out of our future conversations.

After filling out this form we will have a 20-30 minute phone conversation  to see if we're a good fit for each other. If  it's a yes, we'll take it from there.  I look forward to speaking!

 💖✨

 THIS INFORMATION IS CONFIDENTIAL and will only be reviewed by Elana-Karen Leopold.
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Email *
What is your Family/Relationship Status?  *
First Name *
Last Name *
Phone (for WhatsApp) *
Age *
Where are you located? (City and Country) *
Gender *
What is your work/profession and/or studies? *
Why do you want Somatic & embodiment coaching/support? Why now? *
What are some of the challenges, issues you are currently facing in your life, personally and/or professionally that you know you want to work on. Please take some moments to share with me about 2-3 topics. *
Have you done other personal and/or professional development work? (Therapy, coaching, seminars/workshops, other methods). If so, tell me a about those experiences. What did you learn about yourself? What were your biggest insights? *
What's something you're feeling really good about in your life right now. (If you don't have something "really good," the something that feels *more* good) *
On a scale of 1-10, how would describe your body connection *
Almost not at all connected - not something I think about at all
Super Super Connected - I know all the in's and outs of my body's language
Have you done other embodiment, movement, somatic or cycle-work practice? With what regularity? *
On a scale of 1-10 how ready are you to commit to yourself - your growth, your life and show-up fully to transformative work? * *
Very Hesitant
Nothing can stop me now
(If relevant) Please tell me a little your relationship to your menstrual cycle.  

Is your cycle regular?  

Do you chart/track your ovulation? (Please note, this is different than an app telling you when you are ovulating and tracking your period in an app)  

How would you like your relationship to be? *
Do you currently take hormonal birth control (pills, novaring, IUD etc...) *
Are you currently taking mood altering pharmaceuticals on a daily or regular basis? (Ie SSRIs or others) *
Tell me something you like about you! 😊 *
Link to Instagram handle or Facebook (so I can get to know your face (and you!) a little bit more 😊) 💖
My 1:1 work is deeply transformational and rooted in cyclical seasonal perspective. To honor the depth of this work and stay in integrity with the cycle  
I work in containers that are a minimum of one season (3+ months). In some occasions with new clients, I offer an introductory 5 session container.  
 *
I'd like to be added to Elana-Karen's mailing list to receive future updates about her work *
✨ Thank you for taking answer. I look forward to meeting you more deeply ✨
A copy of your responses will be emailed to the address you provided.
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