Clarity Call Application Form

Registration Form
Thank you for your interest in a complimentary clarity session. This call is a space for women who carry significant responsibility and want to explore support that is grounded, relational, and sustainable. This form helps me understand whether this is the right space for you, and whether I’m the right person to support you.
Once you submit this form, you will be taken to my calendar where you can chose the most suitable day and time for our call. I look forward to connecting with you.
General Information
What best describes the level of responsibility you currently hold?*

Senior Leader / ExecutiveBusiness Owner / FounderProfessional with significant responsibilityCurrently in transitionOther (please specify)
Other
Which of the following best describe your current experience? (Select any that apply)*

I’m relied on by others and rarely feel truly supportedI’m functioning well, but something feels unsustainableI feel emotionally responsible even when I’m exhaustedI feel mentally and emotionally “on” most of the time, even when I need restI’ve outgrown most support spacesI’m not in crisis - just tired of holding everything togetherOther (please specify below)
Other
*Please be as specific as possible.
How is this currently affecting you day-to-day? (Select any that apply)*

Poor or disrupted sleepLow energy or difficulty recovering, even when I’m trying to take care of myselfFeeling disconnected from myself or my bodyDifficulty switching off or fully restingHeightened stress held in the body (tension, fatigue, restlessness)It’s not showing up physically - it’s more internalMy sense of clarity or directionOther (please specify below)
Other
*Please be as specific as possible.
What forms of support have you already tried - and what didn’t quite land for you? *
*Please describe the services you bought and the duration of the programmes.
What draws you to a slower, relational approach at this point?*
If nothing changed externally, what would you want to feel more anchored or settled inside?*
What are you willing to do to achieve your desired outcome?*
What feels most important for you to explore or be supported with right now and what are you hoping that support will give you?If this work were supportive in the right way, what would be different about how you hold yourself day to day?*
What made you decide to book this call now?*
If nothing changed over the next 6 months, how would that feel for you?How ready do you feel to explore this properly right now?*
Personal Information
Your best E-mail*
example@example.com
Full Name*

First NameLast Name
Phone Number*
Age group*
Country of residence*

Country

Country
How did you hear about us?*
Comments / Anything else you think I need to know (optional)
Should be Empty:

Registration Form

Once you submit this form, you will be taken to my calendar where you can chose the most suitable day and time for our call. I look forward to connecting with you.

General Information

Personal Information