Free Discovery Call

Once you complete the application you can schedule a time for us to chat via Zoom

First Name *

Last Name *

Phone *

Email *

How Old Are You? *

What Is Your Occupation? *

Relationship Status (If Married How Long Have You Been Married? *

How Committed Are You To Your Healing Journey? *

Have You Sought Any Other Forms Of Help (Therapy Or Counseling) For Your Current Situation? *

What Is Your Biggest Stuck Point In Relationships? *

What Kind Of Guidance Or Support Are You Seeking? *

If you schedule a call with me, will you commit to showing up? *

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