Life Coach and Counselor Application
The "Professional Guidance" Page I manage is for the benefit of my listeners and followers. They hold a place near and dear to my heart and all life coaches and counselors I establish a network with are an extension of my devotion to them. All information will be included on WithPolyAnna.com on the "Professional Guidance" page unless indicated otherwise. Inclusion on the page is not guaranteed to applicants. I do not charge a fee to include you on this page. I reserve the exclusive right to add or remove applicants from this page at any time. You can request to have your listing removed at any time. I follow up personally with each applicant(s) to review responses. Please fill out this form as completely as you can and within your level of comfort. Should you need to update your information at any time please contact me and I will send you the form for updates. This form is a living document and is subject to updates by me at any time. As you well know, potential clients are often in crisis or may be in an emotionally elevated state. It is important to me that your answers protect your time and space establishing reasonable boundaries for access to you. I am grateful to you for your generosity offering your skills and abilities to those in need of them. <3 Poly Anna
Full Name(s) and Business Name
Your answer
Guidance Title
Contact Phone Number for Poly Anna (including area code)
Your answer
Contact Phone Number for Potential Clients (including area code)
Your answer
Contact Email for Poly Anna
Your answer
Contact Email for Potential Clients
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Biography (2-5 sentences)
Your answer
Degrees/Certifications (include accrediting body)
Your answer
Areas of Specialty
Your answer
Are you available for remote counseling?
What is your remote counseling availability? (number of session limits, times, days, etc.)
Your answer
What is your rate for remote counseling? (will NOT be published on "Professional Guidance Page)
Your answer
Are you available for in-person counseling?
What is your in-person counseling availability? (number of session limits, times, days, etc.)
Your answer
What is your rate for in-person counseling? (will NOT be published on "Professional Guidance Page)
Your answer
What other services/products do you offer or want advertised?
Your answer
Website
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Social Media Links
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What location(s) do you offer in-person counseling?
Your answer
What are your biases?
Your answer
What sex subcultures do you have experience working with?
Your answer
What are your thoughts on ethical non-monogamy?
Your answer
What are your thoughts on gay conversion therapy?
Your answer
Describe your counseling methods/methodology?
Your answer
What would you say is your personal philosophy as a counselor?
Your answer
What is the meaning of life? (obviously 42, but beyond that)
Your answer
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