Discover Session Application

Working Together Application

By filling out this questionnaire, I'll learn a little bit more about you, and we'll make full use of our time on the phone. It helps us get straight to your core issues and desires. Please be as honest as you can.

* Indicates required field

Name *

First

Last

Email *

If you are in a country other than the US, do you have access to Skype? *

Yes No I prefer to use my phone

What is your line of work or primary endeavor? *

How long have you been doing what you're doing now? *

Describe the area of your life that is causing you the most concern right now. *

How is this affecting you? *

Have you tried other methods for resolving this, and if so, what? *

What were your results and/or issues with that method? Why did you stop? *

Are you currently taking or have you ever been on the consistent use of pharmaceuticals designed to alter mood or behavior? *

What will your life look like once this issue is resolved? *

Are you coachable, will you be 'willing to do the work' and available for feedback interviews when requested? *

Would you be available for on camera testimony once your program is complete? *

Are you the primary decision maker regarding fincances in your household? *

Yes No It's complicated

Is there anything else you'd like to share with me before booking your appointment? *

Submit

Thank you!
The confirmation link should take you to my booking calendar for a Discovery Session.
If that doens't happen, please email clientcare@spiritsourceconnect.com.
Mahalo ~