1:1 Mentorship Application with Patrice
Hi there. 

Please fill out the below form and then I'll contact you to work out a time for us to chat. Serious applicants only.

Feel free to email me at patrice@patricedouglas.org if you have any coaching inquiries. I don't bite! Clearly state your intention and question in your email.

Much love, Patrice 
Email *
Name *
Email  *
Mobile *
Where are you located (Country, Timezone etc.) *
Where do you want to be in a years time? *
Where do you see yourself in 5 years? (The sky is the limit)
 *
What does life look like today? *
Tell me more about your situation? Give me detail. What have you tried so far? *
How does the above impact your life today? How does it impact your time? How does it impact your emotions? How does it impact other people in your family? *
What made you feel inspired to work with me?
 *
Do you want my help? *
Required
Which coaching option are you interested in applying for? Payment plans available. *
DO NOT SUBMIT THIS FORM IF YOU ARE UNABLE TO MAKE PAYMENT

Are you ready to make the investment?
 *
[Please skip this question if you plan on paying in full]

Which payment plan are you interested in?
1 MONTH : $800 AUD x 2 (fortnightly payments)
3 MONTH : $1300 AUD x 3 (monthly payments)
 *
How did you find Patrice? *
Thank you so much for filling out this form.
I'll be in touch soon to organise a time to have a chat.

Woop woop!

Big Love, Patrice xx
Terms and Conditions

This is NOT mental health therapy or counseling, legal, financial advice, or medical advice. Please contact a professional for mental health, legal, financial or medical advice.

My coaching suggestions are based on my personal experience and that of hundreds of my client's success.

Results vary from each person. 

There are no refunds - all sales are final. 

A copy of your responses will be emailed to .
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