Sign in to your Google account to fill out this form
This form contains features which require sign in. Your identity will not be revealed.
Breakthrough to Confidence Discovery Session Application
I only have five spots available for these sessions and I want to reserve them for the mothers and daughters that I’m certain I can help.
IMPORTANT: You must answer ALL the questions to be eligible for a FREE session.
What is your biggest fear or frustration related to your daughter?
What would you like to change or make different about your daughter's behavior or choices?
What do you worry about and what keeps you up at night in regards to your daughter?
What is the biggest result you'd like to see with your daughter?
On a scale of 1-10 (10 being the highest), how important is it to you to get this issue resolved?
What other kinds of help have you sought to resolve this?
What would help you achieve this result?
Online confidence course
Coaching for your daughter
Coaching for you
Coaching for both you and your daughter together
Retreat or conference for you and your daughter
How much time would you invest in getting this result?
How much would you be willing to invest to get that ultimate result?
What would you like to learn more about?
Stress Management skills
Heart centered listening
Setting ground rules and boundaries
Mindfulness and meditation
Social and Emotional Skills
Mother Daughter Relationship
Friendships and Dating
Send me a copy of my responses.
Please complete the captcha before submitting the form.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service