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After you send the form below, you will be redirected to a booking calendar.

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Most calls are completed in 45 minutes, although we may go over. Can’t find a time that works? contact me

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Begin Survey

This survey is required before scheduling a zoom call. The information you provide is confidential and encrypted for your security.

Please allow 10 minutes.

First and Last Name(required)

Email(required)

Phone(required)

Birth Date(required)

How did you hear about my service?(required)

Please explain the problem you are experiencing.(required)

How does this issue impact you and your life?(required)

What have you tried to solve it?(required)

Where did you get stuck? What stopped you?(required)

What is the outcome you want and how is it important to you?(required)

What's the BIGGEST obstacle in achieving this outcome?(required)

Are you currently under the care of a licensed health professional for this issue or one related? If so, please explain.(required)

How much of a priority is resolving this issue?(required) Most important

Important, but other priorities come first

Not important

Someone else wants me to do this.

How willing are you to invest in yourself and your change?(required) 100% I will find a way to do this somehow.

Willing, but not sure how much.

I don't want to.

Do you have the financial resources to invest in changing yourself and your life?(required) Yes, I have the finances now.

Yes, I can get access to the finances if I really want to do this.

No, not yet.

How might your life change when you achieve your goal?(required)

Do you agree to be somewhere quiet, private, and undisturbed for your call? (Please no driving!)(required) Yes

You will be redirected to a booking calendar when you press send.

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