First name*

Last name*

Email*

Phone number*

Which program are you most interested in?

1v1 Mindset Coaching

Small Group Coaching

Yoga Teacher Mentorship

Masculine Embodiment Mentorship

Are you currently working with a therapist or counselor?*

Yes

No

Have you ever been diagnosed with a mental health condition? *If yes, please describe.*

What is the primary challenge you’re working to overcome?*

Which of the following do you most identify with and why? (Victim, Perpetrator, or Rescuer)*

Describe your top 3 goals for the next 12 months...*

What do you hope to achieve by working with me?

Submit