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Work With Me Intake Form

What's your full name?

What's the best email to reach you?

What is your phone number?

Tell me a bit about the goals you have for your life. Be specific please.

Why are you interested in working with me?

What are the specific goals or challenges you hope to address?

My time is very valuable to me. I need you to be ready and willing to do the work, otherwise it's a waste of my time. Do you commit to following through in the process of attaining your goal or overcoming challenges?

Are you ready to commit to leaving behind old identities based in victimhood and stop making excuses in your life?

I reserve the right to cease contact and working with you if you violate my boundaries and disrespect me with inappropriate behavior. Our relationship is strictly on professional terms.

What time of day generally works best for a call?

Are you available on Saturday's?