Full Name *

Email *

Phone

Time zone *

What best describes your current season? *

Feeling stuck or disconnected

Navigating a major life transition

Recovering from a toxic relationship or environment

Burned out professionally

Ready for clarity, confidence, and calm

Other

What feels most challenging for you right now? *

How long have you been feeling this way? *

Less than 6 months

6–12 months

1–3 years

Longer than 3 years

Why is now the right time for you to explore coaching? *

On a scale of 1–10, how committed are you to doing the work required for change? *

1–3

4–6

7–8

9–10

Are you open to investing in yourself if this feels aligned? *

Yes

Possibly / I have questions

Not at this time

Have you worked with a coach or mentor before? *

Yes

Is there anything you’d like me to know before our call?

Final Acknowledgment

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