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Apply For Financial Assistance
Please complete this questionnaire to apply for financial assistance. Within a couple of days of your application, I'll send you an email to confirm I received your response.
I have my fingers crossed for you! :)
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What's your full name?
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Your answer
How old are you?
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Your answer
What's your email?
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Your answer
What's your occupation?
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Your answer
What do you feel are the things holding you back from achieving your vaginismus goals? What do you feel are your major stumbling blocks?
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Your answer
How committed are you to overcoming what is holding you back?
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Kind of committed - I'll see how it goes..
Totally committed - I'm ready to do what it takes!
Is there anything else you would like me to know?
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Your answer
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