Strategy Call Application

Please fill out the form below so we can properly prepare for your appointment.

First Name *

Last Name *

Phone *

Email *

Full Address (not required unless you would like to receive holiday cards or special promotions)

Check each area in which you have you lost your passion and/or purpose - Where do you feel the most stuck? (check all that apply) *

Which of the following negative emotions do you continue to carry around with you from past traumas or past life experiences? *

This is a safe and confidential space. If you recall a specific event from your past that may be the cause of this problem and you are comfortable sharing, please do so. Perhaps, we can address it and take care of it immediately on our call.

What do YOU THINK is your Biggest Problem? The one you would like to solve first? *

List 1-3 (one to three) things that you say to or about yourself when you look in the mirror? #1, #2, #3 *

What do you feel is your biggest obstacle in getting you past or over these issues? *

What have you done to try and get rid of the problem? *