Client Application
Stacie Ysidro, Holistic Progressions contact form. Everything is strictly confidential, I do not share information with anyone! Fill out this form so we can plan a complementary exploration phone call. We will clarify your needs, see what is holding you back and brainstorm on how to get you there. We will determine if we are a good fit to work together and discuss options for moving forward.
holisticprogressions@gmail.com
Sign in to Google to save your progress. Learn more
Email *
Full name *
Age *
What is your preferred method of contact? list the email or phone number for me to use to contact you. *
Occupation/field of work *
How did you find me? *
Gender Identity/Pronouns
Clear selection
Relationship Status
Clear selection
What made you seek Coaching? What is your main concern/problem you want help with/goal you want to achieve ? *
What have you done to address the concern? Of the things you have tried to help yourself so far, what has worked and not worked?
What do you hope to accomplish by working with me? *
What fears do you have about getting help with your problem/ achieving your goal?
How much time are you willing to invest in solving your problem/achieving your goal? *
how would you like to be helped? *
How much are you willing to financially invest in achieving your goal? *
What is your preferred method of contact?
Clear selection
Are you taking prescribed or OTC medicines for medical conditions that would affect your sexuality? (ex: blood pressure, antidepressants...) *
How much do you value collaboration, creativity and personal growth? *
not at all
very important
If nothing was holding you back ( no limits) and you could have your life the way you want it...what would that look like? think big! *
Is there anything else you want me to know?
When is the best time to plan your call? Make sure you will NOT be driving, distracted and can speak freely. (I am on eastern standard time) After submitting this form use my calendar link to schedule a call
Do you want to be added to my mailing list to receive monthly newsletter? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms