Professional Mentorship Application

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You are taking the first step to join our practice to start, grow and evolve your own professional practice as a mental health or wellness provider.

Please complete the form bellow and Michelle will be in touch with you within one week.

Looking forward to connecting with you!

With gratitude,
Michelle

__________
* Please note that this form uses the Google platform and confidentiality may not be guaranteed.

First Name *

Email *

Phone *

What are your preferred pronouns? *

What is your age? *

Where do you currently live? (city/state + country)

Where were you born? (city/state + country)

Please mention here any identities that are important to you that you would like to highlight?

Any specific support you're seeking? *

Select all that apply.

Starting my private practice

Growing my private practice

Support in running a fully virtual private practice

Address imposter syndrome + burnout

Life / work balance

Reclaim joy in your work

Hone in on your niche

Define and reach your ideal client

Set your ideal schedule

Diversify income

Integrating a mindfulness and compassion based-approach

Integrating a mindfulness and compassion based-approach in my work

Supervision for pre-licensed professional seeking licensure in RI or PA

Other:

Required

Imagine that we are working together and you are feeling the experience is deeply valuable to you. How will you know when you are receiving VALUE from our work together? *

I will know this process is working when...

Would you be interested in participating in a virtual professional mentorship group for mental health and wellness professionals?

Michelle runs mentorship groups based on the belief that in groups, the interplay among participants provides a rich learning space for exponential growth.

Yes I am interested in joining a virtual mentorship group

No I am not interested in joining a virtual mentorship group

Other:

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Ideally, when are you available to schedule appointments? *

Select all that apply.

Before 10AM

Between 10AM and 4PM

After 4PM

Weekends

Required

Investment acknowledgement *

Professional mentorship with Michelle is a deeply nourishing journey that requires a 3-month minimum commitment starting at US$500 per month. Is this an investment you are fully commitment to make in this season of your life?

Yes, I am ready for this investment.

No, I am not ready for this investment at this time.

Required

Any specific question(s) that you would like answered about Professional Mentorship with Michelle?

How did you hear about Michelle and her work?

Would you like to be added to Michelle's newsletter? *

Michelle sends emails every few weeks with updates about groups and workshops plus gentle inspiration, practices and insights to support your emotional wellness.

Yes, please!

No, thank you.

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