Coaching Application
Submitting an application does not guarantee a spot in the coaching program. Should your application be selected, you will be emailed a link to provide payment. The spot is yours once payment is received.
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Email *
Name *
Timezone *
How long have you been out of a toxic relationship? *
Describe your past experience with therapy? What was helpful/not helpful? *
What are you hoping to get out of coaching? *
Why do you feel coaching is the right thing for you? *
I understand by submitting this application, I am acknowledging that I am willing and able to commit to the full six weeks and am willing and able to pay the program cost should my application be accepted. *
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