Private Coaching Application

Tell Me About Yourself

Before we connect, I want to understand where you are and what you're ready to transform. Take your time with these questions — the more honest you are, the more valuable our conversation will be. There are no right or wrong answers here. Only truth.

This form takes 10–15 minutes to complete

First Name *

Last Name *

Phone *

Email *

Which Course Are You Interested In? *

Identity Shift

Internal Recode

SECTION 1: Where Are You Right Now?

What is currently not working in your life or relationships that brought you here? *

What have you already tried to change this pattern — and what hasn't worked? *

If nothing changes, what does your life look like 6–12 months from now? *

SECTION 2: Pattern + Shadow Awareness

What pattern do you find yourself repeating most often (in love, work, or self-worth)? *

When this pattern shows up, what do you tend to feel in your body? (tightness, anxiety, numbness, etc.)

What do you believe this pattern is protecting you from? *

Where do you think this pattern may have started? (childhood, past relationship, identity role, etc.) *

SECTION 3: Chakra + Emotional Landscape

Which of these areas feels most out of balance right now? (select all that apply) *

Where in your life do you feel the most disconnected from yourself? *

Where do you feel the most activated or triggered right now? *

SECTION 4: The Unshadowing Method

Where are you currently giving your power away — or blaming something outside of you? *

What truth about yourself feels hardest to admit right now? *

What are you avoiding that you know is part of your next level? *

SECTION 5: Desire + Expansion

What would your life look like if this pattern was no longer running the show? Be specific. *

What kind of relationship do you actually desire — with yourself or a partner? *

SECTION 6: Readiness + Investment

Why do you feel now is the time to change this? *

On a scale of 1–10, how ready are you to take full responsibility for your transformation? Why? *

Are you willing to be honest, uncomfortable, and consistent in this process? *

Optional:

If accepted, are you prepared to financially and energetically invest in your transformation?