1 -on- 1 Pathway Coaching Application

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Thank you for taking the time to fill out this important form. It tells me you're serious about healing your grief and you're done waiting for "time to heal all wounds".

1-on-1 coaching is very personal to each one of us. And so, to see if you and I are qualified to work together, it's imperative I understand where you are right now on your grief journey and that you're prepared to invest in yourself now.

Please take a few minutes to answer ALL of the questions on this form to the best of your ability. Your answers stay with me, only.

Note: When the application is complete and submit your responses below, I will personally review the application, and I'll email you directly for next steps.

Email *

What is your first and last name? *

What name (or nickname) do you prefer to go by? i.e. Elizabeth "Liz". *

How would you rate your current level of grief? *

Mild, I'm coping well.

My grief is "there" , kind of like a dull throbbing pain... I live with it.

I'm good and then I'm not good

I'm struggling a lot

I'm inconsolable at the moment

I don't want to live any longer...

Specifically with your grief, what are you struggling with right now? i.e. I feel like I'm stuck. I feel like no one is there to support me. I don't feel like people understand me. (Be as specific as you can with where you are. It's ok. I'll hold space for you on our free call.) *

What, if any, progress have you made in the last 3-months? *

Why would you want to work with a grief coach? *

Does it matter to you if your coach has gone through a similar loss as you, no matter the relationship? i.e. I only want to work with a coach that's lost a child, or a spouse, etc.. *

Yes

Have you ever worked with a coach before? If so, what were the outcomes? *

What specific goals would you like to achieve working with me as your grief coach? *

What pains you the most right now about your grief? *

It's 3am and you're wide awake? What is keeping you from falling back asleep? *

This "customized-for-you" 1-on-1 coaching program with me is an investment in YOUR healing journey. This 12-week program is $2,997 for the 12-week program. Are you willing to invest in yourself at this time? *

Yes, I want to invest in myself at this point of my journey. I realize I can't go it alone any longer and I want to get on a path of true healing.

No, I don't want to accelerate my healing and get to the root of my grief. I'll let time do it's thing.

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