Make an appointment
Please fill in the questionnaire below to make an appointment with me. At the end, you'll be prompted to schedule a time for our session. Please whitelist firstname.lastname@example.org in your email provider so that you can receive important information about your session from me. I'm looking forward to helping you heal your hurt.
What part of yourself are you currently neglecting?
Please rate your desire for change.
I don't really want this to change
I want this to change right away
1 is I don't really want this to change, 5 is I want this to change right away
What kind of support have you already tried or used to help solve your problem? You can tick multible boxes.
Meditation or mindfulness
Which coaching option are you most interested in?
Life Re-Design System
Life Exceleration Plan
Life Up-Level Mastery
When would you be ready to start coaching?
In 1 month
In 2 months
In 3 months
Have you already done the Life-Re-Design Plan - Re-Design Any Part of Your Life in 90 Days?
Have you already followed any of my online courses?
Self-Love Activation Course
Is there anything else you'd like for me to know?
Click here to submit your answers and to choose a date and time for your appointment
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm