SECTION 1: WHO ARE YOU, REALLY?

Name

Email address

Phone number/Whatsapp

Where are you based? (City + time zone)

What do you do for work — and how do you currently feel about it?

SECTION 2: WHAT IS GOING ON INSIDE?

What drew you to this work — and to me specifically?

Where in your life do you feel blocked, stuck, or off-track?

What patterns keep repeating that you’d love to shift?

How do you typically handle pressure, stress, or disconnection?

What is something you haven’t said out loud to anyone — but feel safe sharing here?

SECTION 3: WHY NOW?

Why now? Why you? Why this?

What would feel like a powerful shift or outcome from our work together?

What is at stake if nothing changes?

What are you willing to let go of — to access what’s next?

How would you love to feel 90 days from now?

SECTION 4: HOW YOU SHOW UP

Have you worked with coaches, therapists, or guides before? What worked / didn’t?

Are you comfortable being emotionally open in a sacred container?

YesSometimesNot sure, but willing to try

How do you respond to intuitive, non-linear, energetic work?

I love itI’m curiousI’m skepticalI need structure

Are you ready to meet parts of yourself you have avoided?

AbsolutelyI think soThat scares me a little

What support structure or community (if any) do you have around you?

SECTION 5: PRACTICALS + COMMITMENT

Which type of container feels most aligned for you right now?

1:1 Single Deep Session (day-long)1:1 Multi-Session Journey (1–3 months)Not sure yet

Are you in a financial position to invest in this kind of deep work?

YesWith planningNot right now

How soon would you like to begin?

What is the best way to contact you? (Email / phone)

EmailCall

Is there anything else you want me to know or feel into before we connect?

This work only begins when you’re ready. If this application is honest — that’s more than enough. I’ll review and reach out if I sense alignment.

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