Consultation Request
I learned and OVERCAME many tragedies in my short 30 years of life. I don’t want someone to be lost for 10 plus years like I was--there is no need for it.

Today, I am an adaptive athlete, professional speaker and advocate for the disabled.

I would like to be your mentor, helping you navigate the challenges of disability, so that you can succeed in all aspects of life. You can reach your potential.

Let's work together.

IF YOU CAN, I CAN TOO.

Full Name
Your answer
Email
Your answer
Age
Your answer
City
Your answer
Country
Your answer
Your Preferred Video Conference Platform
Video Conference User Name
Your answer
How long ago was your injury approximately?
MM
/
DD
/
YYYY
What is your spinal cord level of injury
Your answer
What were some of your hobbies prior to your injury?
Your answer
Are you currently working?
Your answer
What are some of your passions?
Your answer
Do you have children?
Your answer
What are your short and long-term goals?
Your answer
Ideally, when would you like to begin consultation?
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms