Private Client Interest Form: Begin your journey back to yourself.
Thank you for your interest in working together. This isn’t a sales form — it’s a way for me to understand your goals and make sure this experience is the right fit for your season of life. Everything you share is confidential and honored with care. 🤍
Name*
What made you curious to fill this out today? *
What are you currently struggling with?
What would you love to feel instead?
What’s your biggest fear if nothing changes?*
What’s your ideal timeframe to begin?
As soon as possible
Within the next 2 weeks
In 1–2 months
Not sure yet — just exploring
Are you prepared to invest in your transformation?
Yes, I’m ready to invest in myself
Possibly — I’d love to know the options
Not right now, just curious
Anything else you’d like me to know?
When are you generally available for sessions (in your timezone)?*
Weekday mornings (before 12 PM)
Weekday afternoons (12 PM – 5 PM)
Evenings (after 5 PM)
Weekends (Sat/Sun only)
My schedule varies — I’m flexible
Email address*
Phone number *
What city and state (or country) do you live in?*