Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *Where are you in your life / relationship right now? *SingleDivorcedSeparated DatingIt;s ComplicatedMarriedIn a Challenging Marriage What is currently your biggest challenge? *If you had a magic wand what would be the ideal solution for your problem? * On a scale from 1 to 10, how much do you want change and alleviate the frustration/pain you told me about above? *What do you believe would need to happen to make this change a reality? * How committed are you to doing the work it takes to create a better life for yourself? *On a scale from 1 to 10, how much are you WILLING to invest in the TIME, ENERGY, and MONEY that coaching involves in order to help you manifest the life and love you desire? *What have you tried in the past to improve or change the things in your life that where hurting, you, or holding you back from living the life you desire? *Are you afraid of and resistant to change? *Yes NoDo you believe you deserve a better happier life? *YesNoWhat are some obstacles within yourself preventing you from getting that life? *What would be your ideal situation right now? How much are you willing to invest in order to change your mindset, overcome your limiting beliefs, heal your past wounds, so you can create the life you desire in a short period of time? *$1KBetween $1-$3KMore than $5KI understand that I will be called at our appointment time and I will be available for the call! *YesNoI have double-checked the time I choose based on my time zone and I know without a doubt when my call is and I've already put it into my calendar in case the confirmation email goes to spam *Yes NoCommentSubmit