Page 1 of 2

Discovery Call - Fill out the form

How old are you?

What behaviors or patterns are you currently struggling with, and how are they affecting your daily life, relationships, or confidence?

How long has this been an ongoing issue, and what have you already tried to fix it?

What is this problem currently costing you emotionally, socially, or professionally?

If nothing changes in the next 6–12 months, what do you realistically expect your life to look like?

Why does continuing as you are no longer feel acceptable to you? Why now is the time to change?

On a scale of 1–10, how committed are you to doing the uncomfortable work required to change?

On a scale of 1–10, how committed are you to doing the uncomfortable work required to change?

Are you able and willing to invest financially in your recovery?

Are you able and willing to invest financially in your recovery?
A
B

What's your full name?

What is your e-mail address I can reach you on?