Ignite Your Potency Application
Dr. Hazel-Grace Yates and Melissa D are THRILLED about your interest in our program. The purpose of this application is to ensure both you are a good fit for this program, and our program is a good fit for you!

Thank you for your time, vulnerability and heartfelt thoroughness completing this confidential application.

All of your informational will be kept confidential.

The next step in the process is to have an Ignite Discovery call with Melissa or Hazel-Grace to ensure this program is a great fit for you and to answer any questions you have.
You will be contacting within 72 hours to set up this powerful conversation.

In the meantime if you have any questions at all for either one of us, please contact us at:
hazelgraceyates@gmail.com or melissa@bodyjoy.org
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Email *
Name *
Physical Mailing Address (*Optional: Participants will receive an Ignite Your Potency Workbook and gift in the mail.)
How did you find out about the Ignite Your Potency Program? *
What are you hoping to achieve, learn or experience in Ignite Your Potency? *
What are you biggest struggles as it is relates to intimacy, relationship or sexuality? *
What are your current support and resources in your life? (friends, therapist, wellness practices or routines etc.) *
What fears or concerns do you have regarding this program? *
Anything else you want to share with Melissa or Hazel-Grace *
A copy of your responses will be emailed to the address you provided.
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