Name *

First Name

Last Name

Phone *

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Possible areas of focus for you *

Please check all that apply.

Adult ADHD

Burnout

Career change

Decision-making/a decision

Empty nest

Habits

Health & wellness

Identity

Parenting

Perimenopause

Purpose/meaning

Relationships/family

Self-care

Time management

Work-life balance

None of these apply to me

Limitations *

My current practice is limited to women between the ages of 40 and 65.

I am a woman aged 40 to 65.

Virtual Meeting Format *

I only offer coaching via Zoom.

I am comfortable meeting over Zoom.

Complimentary "Get to Know You" Zoom *

Once I've reviewed your form, I'll e-mail you a sign-up link for your complimentary (free) "get to know you" Zoom session. Please allow up to two business days for a response.

I understand.

Investment *

The Catalyst consists of three 1:1 Zoom coaching sessions (1 hour each) to be completed within 30 days. The total cost is $295.

I can commit to $295 and three one-hour Zoom sessions in 30 days.

Accepted Payment Methods *

I accept Zelle (preferred) or Venmo. Do these work for you?

Yes, I would be able to pay via Zelle or Venmo.

Pre-Payment Policy *

I require pre-payment in order to book with me.

I understand.

Have you ever worked with a life coach before? *

If you answer yes, I'll ask about your prior experience when we speak on Zoom. If you answer no, I'll answer any questions you have about how my process works.

Yes

No