Coaching Application Form

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Hi! I am so happy that you're here.

I honestly want to start off by celebrating you for wanting to apply for 1:1 coaching with me! This shows me that you genuinely invested in taking care of yourself and becoming a better person and I think that's amazing!

Please take a moment to complete this application so I can better understand your current situation, what your goals and the kind of support you're craving right now.

After you complete the application, on the next page, you'll get a link to book a 90 min 1:1 free consultation over Zoom where we'll dive deeper into creating a plan that will address the challenges you explain and goals you'd like to achieve, below.

The more detail you share, the better recommendations I'll be able to make.

This free consultation is reserved for women who..

A) have decided that coaching with me is perfect for them and are ready to get started.

B) serious about hiring the support of a coach and would like to use this consultation to see if we’re a great fit for one another.

Please only sign up if you fall under either categories.

Thank you!

P.S You'll be sent the link to book a consultation with me only once you've completed these questions.

First and last name *

Email *

Phone number - please include your country code *

Instagram handle *

I prefer to be contacted via... *

Instagram

Required

Tell me a little bit about your situation, be it your relationship and/or breakup?
*

If you’re going through a breakup, tick all the challenges below that you can relate to.

You’re struggling to be comfortable alone, you feel very anxious, empty and lonely

You’re feeling lost post break up like you don’t know who you are anymore. You’ve had questions like… “Who am I without him/the relationship? He was my entire world.”

Keep breaking down randomly throughout the day, you’re heartbroken and/or feeling depressed

You keep beating yourself up for all the mistakes you’ve been, regretting the choices you made, feeling lousy about yourself

Your self-esteem has taken a hit, you keep questioning your self-worth, wondering if you’re good enough

Finding yourself wanting answers to have another conversation although it may not benefit your healing process

You find yourself needing to constantly distract yourself with work and other social activities to avoid feeling the pain

Required

What are some of the issues you're facing, or tend to face, in a relationship? Tick what’s relevant to you below.
*

I put my relationship at the pedestal to the point that I don’t spend as much time with my family/friends, doing what I like, that my career takes a back seat (even if it’s important to me)

I am over-sensitive to his moods, when I feel like he is pulling away, doesn’t text back as quickly as you’d expect or like him to then, needs his own space, when there is an argument in the relationship, you start feeling extremely anxious and find it hard to sleep or focus

I tend to bend over backwards to make the relationship work (accommodate to his schedule, change who I am to be more desirable, always initiate meetups/dates messages)

I'm constantly chasing, or begging, for love and affection in relationships/tirelessly chase for love and validation 24/7 in relationships to feel secure about yourself and the relationship

I am super clingy and needy, I need to be in constant close contact (virtual or physical) with my partner and/or need constant love and reassurance to feel safe in relationships

I turn a blind eye to hurtful behaviours and/or fail to enforce boundaries

I feel insecure when he hangs out with his friends/goes out

I tend to stay in relationships that have way past their expiration date or relationships that are unhealthy/toxic/with partners that aren’t a great match for me

Required

What have you tried before to overcome these challenges? Why do you think your current strategies haven't fully worked? Tick what’s relevant to you below.

Therapy/counselling

Spoken to friends/family

Read self-help/relationship/breakup books

Consumed online content pertaining to breakups and/or relationships (podcasts/tiktok/ig/youtube)

Tried dating new other people

Filling up my calendar with work and activities

Drinking

Journaling

Meditating

Required

What do you really really want to achieve from this program? What are your desired results? Tick what’s relevant to you below.

I want to be at peace with myself, how I showed up in the relationship and the breakup

I'm happy and secure alone, I want to see myself happily doing things alone, that are important to me, but also fully present and enjoying time spent with your friends/family, my happiness is not solely dependent on having a partner in my life

I am emotionally self-sufficient, I am able to sit with my uncomfortable feelings, self-regulate, self-soothe, and meet my own emotional needs (love, acceptance, happiness, safety etc..)

I can trust myself to make my own decisions and have my own back no matter what

I want to feel whole and complete with or without a partner, or my ex,

I am unaffected by my ex, whether he has moved on and/or is happy without me

I want to become a more confident person and have more love for myself

I want to feel more confident that I’ll be able to show up as my best, most confident and secure self and learn everything that’s required to have a healthy and happy relationship

My self-worth is no longer dependent on whether my romantic partners love me or not, I feel enough as I am

Required

In your next, or current relationship, how would you ideally like to show up? I want to be someone who…Tick what’s relevant to you below.

Stays true to who she is, sets and enforces boundaries with confidence

Has an amazing life outside of her relationship, who also prioritizes her alone time/time with friends/family and who is fulfilling her full potential at work - thriving relationship and career!

Is able to regulate her emotions and self-soothe without overwhelming her partner, has confident in her ability and to manage her own emotions and wellbeing

Is able to manage her emotions and relax when there’s a fight/argument, partner is busy, when he hangs out with friends (females included) and get enough sleep and/or focus on what’s important to her

Able to navigate challenging conversations confidently and come up with solution with her partner

Feels secure in her partner's love and commitment, there’s no need for constant need for reassurance, validation and contact

Trust in her ability to leave when the relationship is clearly not working/or aligned with her and trusts that she’ll be ok even if it ends

Feels confident in her ability to choose partners that are a good match for her

Why is it important for you to work on these goals now?

For our call what do you have in mind? Option A or B?
*

A) I've already decided that coaching with Ambra is perfect for me and I am ready to get started and invest in myself.

B) I am serious about hiring the support of a coach and I'd like to use our call to make a decision whether I'd like to work with Ambra.

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