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Self Expansion Application
Please fill out this form to the best of your ability so that I can see if we're a good fit for this container.
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Email
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Your email
Name
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Your answer
Phone number
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Your answer
Occupation
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Your answer
Age
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Your answer
What is your intention for joining this container with me?
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Your answer
What have been your barriers in creating these changes for yourself?
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Your answer
What type of container are you ready for?
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something I can do in a weekend
something I can schedule occasionally
a 3-6 month immersive experience
How ready are you to make the necessary changes to transform your life? (1-10)
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not at all
1
2
3
4
5
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9
10
100% committed
How ready are you to invest in yourself? My programs run from $600-3,000 (payment plans available)
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not at all
1
2
3
4
5
6
7
8
9
10
ready to invest now
Why do you want to work together? Why now?
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Your answer
Are you working with any other practitioners?
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Your answer
Have you worked with any other coach/practitioner in the past? What was your experience?
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Your answer
Is there anything else you want me to know?
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Your answer
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