DISCOVERY SESSION APPLICATION
Congratulations on making the decision to chart a new path to a balanced, healthy and vibrant life - free from the frustrations of stress, overwhelm and the pressure of perfection.
Once your questionnaire is submitted you will receive a personal email from me to schedule your complimentary 60 minute Discovery Session (a $195 value).

Our time together is a powerful opportunity for you to discover what is stopping you, slowing you down or keeping you from creating the life you want.

This session will allow you to get crystal clear on a STEP BY STEP PLAN on how to reach your goals, so you can embody the best version of yourself and live a successful life beyond stress, frustration and overwhelm.

I look forward to getting to know you and our time together!
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This is a 100% judgment-free zone.
Whatever you express here is absolutely perfect and valid, and will be kept in strict confidentiality.

(This application expresses your interest only and you are under no obligation to enroll in any services.)
 
WHAT IS YOUR FULL NAME? *

 
WHAT IS THE BEST PHONE NUMBER TO REACH YOU ON FOR THIS SESSION? *

 
WHAT IS YOUR AGE? *

 
WHAT IS YOUR OCCUPATION? *

 
WHAT IS YOUR SKYPE HANDLE? (If applicable)

 
WHAT IS YOUR #1 GOAL OR DESIRE? *

 
WHERE WOULD YOU LIKE YOUR HEALTH TO BE 3 MONTHS FROM NOW? WHAT ABOUT 6 MONTHS FROM NOW? *

 
HOW WOULD YOU LIKE YOUR LIFE TO LOOK LIKE 3 MONTHS FROM NOW?
HOW ABOUT 6 MONTHS FROM NOW? *

 
WHAT ARE 3 TO 5 OF YOUR GREATEST OBSTACLES, CHALLENGES OR STRUGGLES RIGHT NOW?
(HEALTH AND/OR LIFESTYLE RELATED) *

 
WHAT KIND OF SUPPORT OR SOLUTIONS HAVE YOU TRIED IN THE PAST TO RESOLVE THIS/THESE PROBLEM(S), IF ANY? *

 
WHAT HAS WORKED FOR YOU, WHAT HASN'T? *

 
HOW IMPORTANT IS IT FOR YOU AT THIS TIME TO FIND A SOLUTION FOR YOUR CHALLENGES? *

Please indicate the importance on a scale from 1 to 10:
1 star means it is of very little importance - 10 stars mean it has the highest priority in your life right now.










 
IF YOU FIND A SOLUTION THAT FITS YOUR NEEDS ARE YOU WILLING AND ABLE TO INVEST IN YOURSELF AT THIS STAGE? *

     
 
WHAT ARE 3 TO 5 OF YOUR GREATEST STRENGTHS? *

 
WHAT ARE 5 THINGS YOU LOVE ABOUT YOUR LIFE? *

 
WHAT WOULD YOU MOST LIKE TO GET OUT OF OUR TIME TOGETHER DURING THIS 30 MINUTE DISCOVERY SESSION? *

 
IS THERE ANYTHING ELSE YOU WOULD LIKE ME TO KNOW?

 
HOW DID YOU FIND OUT ABOUT ME? *

 
ACKNOWLEDGEMENT:
• I have completed this application in its entirety and according to what I know to be true.
• I understand that this application expresses my interest only and that I am under no obligation to enroll in any services.
• I acknowledge that with my request for a 30 minute Discovery Session I agree to be available at the appointed time and will give a minimum of 48 hours notice should I need to reschedule.

I AGREE: *

(Please indicate by checking Yes or No)
     
 
PLEASE ENTER YOUR FULL NAME *

 
TODAY'S DATE *

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