Empath Warrior Assessment Form
Thank you so much for your interest in joining the 6 month Empath Warrior Program!

Here are the program details for you to review prior to completing the form:

Thank you for taking the time to fill out this questionnaire.  

We will use your answers to help assess if the Empath Warrior Program would be a good fit for you. Please make sure to drop me a DM once you have completed the form.

If you qualify for the program, then we will arrange a 45min video call to discuss further details. The intention of the call would be to gain a more detailed understanding of your current challenges, and assess the best next steps for you to help you reach your goals of healing.

Please bear in mind that there are limited spots in the Empath Warrior Program. If you qualify for joining the program and would like to join but there are no spots available, then you will be asked to join the waiting list.

When you’re filling this out, go with your gut and your heart.

Don't over think it.  Done is better than perfect.  

I can’t wait to co-create life changing seismic shifts with you.

You are giving yourself a huge gift putting in the effort to create the life you want.  I am honoured to be a part of it.


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Email *
Full Name *
Email Address *
Your Social Media Account Name (Instagram / Facebook / LinkedIn)  *
Why are you considering joining the program? *
Have you joined a Coaching Program before? *
Have you had Therapy or any other form of healing work before? If so please describe. *
How would you describe your biggest challenge in your life right now with being an HSP / Empath? *
What have you tried so far to overcome this challenge? (Please include any form of external support that you may have received) *
What has worked or not worked about what you have previously tried? *
If you are to overcome this challenge, how would it make you feel, and what would that create in your life? *
What goals are you currently working on in your life? *
Be very specific, where are you at with your goals in your own healing, and where do you want to be? *
Describe how you want your life to look and feel in the next 6 months: *
What is your biggest external obstacle in reaching your vision? *
Why outside help, why not continue to try and do this on your own? *
Why is it so important for you to invest in yourself now? *
What would make joining this program a no-brainer for you, and everything you wanted? *
The Empath Warrior Program is £540 / $670 USD) per month over 6 months on the payment plan, or £3,000 ($3,700USD) in Full pay. On a scale of 1-10, how ready are you right now to invest time, energy, and finances into yourself to create the life you want? *
I'm not ready to invest in myself
I am SOOOOO ready and willing!
Would you like me to reach out and book a call to discuss further? *
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