Request an Exploration Call with Amber Wylde

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hello and thank you for your interest in one of my coaching programs! Please take a few minutes to complete the questionnaire below in order to book your exploration call. Once you've submitted your application, I'll be in touch with you within 3 business days. I look forward to hearing from you!

Note: Exploration calls are a mandatory part of new client onboarding and are reserved for people interested in working together through one of the paid offerings available on my site. Please do not book a call if you are not seriously considering working together.

Name (First and Last) *

I like to be called: *

My pronouns are: *

My birthdate is: *

YYYY

My email is: *

My phone number is: *

My address is: *

My gender identity is: *

Cisgender (you identify with the gender you were assigned at birth)

Transgender

Non-binary

Genderfluid/Genderqueer

Intersex

Bigender

Other:

My sexual orientation is: *

Gay/Lesbian

Bisexual

Pansexual

Asexual

Queer

Questioning

Straight ally

Straight parent of an LGBTQ+ child

Do you currently have a faith affiliation? (If yes, please put it in the box below) *

Have you experienced religious trauma? *

Yes

I'm Not Sure

I also identify as: *

POC (Person of color)

BIPOC (Black Indigenous Person of Color)

A person with a disability (If you would like to name your disability, you can do so in the "Other" box below)

Immunocompromised (If you would like to name your medical condition, you can do so in the "Other" box below)

An immigrant, refugee, or migrant.

Polyamorous/Ethically non-monogamous (ENM)

None of these apply to me

Other:

Do you have any accessibility needs? (If yes, please list them in the "Other" box below)
*

Yes

Other:

Which of the following coaching tracks are you interested in? *

Coming Out (6 weeks)

Coming Out (12 weeks)

Deconstructing Faith (6 weeks)

Navigating Chronic Illness (6 weeks)

Navigating Chronic Illness (12 weeks)

Create My Own Package (6 weeks)

Create My Own Package (12 weeks)

A One-Time Individual Session

How did you hear about me? *

What brought you to consider coaching with me? *

What are the biggest challenges you're currently facing? *

What do you desire for yourself on the other side of this experience? *

Is there anything else you'd like me to know? *

On a scale of 1-10, how would you rate your level of commitment and motivation to transform this area of your life? * *

Not committed, just curious.

Completely committed! How do I sign up?

Working privately with Amber ranges from $90-$1800 USD with payment plan options available as needed. With this in mind, which of the following statements below most applies to you today?
*

I'm excited for the journey and able to pay in full

I'm eager to explore and may need a payment plan

I'm not 100% certain I can make this work financially right now but would like to learn more

This is beyond my current financial means but is important to me and I would like to explore possible options

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Living Unashamed LLC. Report Abuse

Forms