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Connection call: Apply for 1:1 Somatic Coaching
This form is to apply for 1:1 coaching with me. Once you've completed the form, please book a connection call with me so we can connect and decide whether this feels right for both of us.
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Email
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Your email
What is your full name?
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Your answer
What is your email address? Please check your e-mail within 48 hours for a response. We will be in touch
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Your answer
What country do you reside in?
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Your answer
Have you worked with a coach in the past?
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Yes, personal coaching
Yes, business coaching
Yes, personal + business coaching
No, I haven't - I'm beginning my journey
No, but I have worked with a therapist/healer
Other:
What are the physical or mental issues you are working with right now?
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Your answer
What is your number one challenge right now?
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Your answer
What are three things you hope to accomplish over the next 1 year?
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Your answer
What do you think is standing in the way of what you want? Are you willing to overcome these challenges to step into the life or state of health that you truly desire?
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Your answer
On a scale of 1-10, how committed are you to working through the deeper emotional issues that may hold you back?
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I'm not committed yet
1
2
3
4
5
6
7
8
9
10
I'm 100% ready now
How much time are you willing to invest in yourself by devoting time each day to suggested practices/activities?
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5-10 minutes a day
20-30 minutes a day
up to 1 hour a day
Are you open to receiving feedback within coaching sessions?
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Yes
No
Maybe
Thank you for your time - I look forward to connecting with you soon.
A copy of your responses will be emailed to the address you provided.
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