Initial Consultation Intake First Name Last Name Email Address Phone What time zone are you in? Eastern time Central time Mountain time Pacific time Alaska time Hawaii-Aleutian time How did you hear about me? Please describe your current situation and relationship that you need help recovering from and share what challenges or symptoms you are currently experiencing. What have you already tried to help yourself with the above challenges? For example, counseling, coaching, programs, alternative healing modalities What are your biggest obstacles(s) that's holding you back? Are you ready to invest in yourself (*does not mean you've committed to anything, but that you're willing to invest your time, money, and energy in getting support to solve your challenges)? Yes No Unsure Which coaching/counseling program(s) are you interested in? (You can select more than one) Basic Breakthrough Group Soul Sisters Moving Forward Group Releasing Trauma Group Individual Coaching package Unsure Anything else that you would like to share? Would you like to join my newsletter? Yes Submit
