First Name

Last Name

Phone *

Are you looking for help conquering anxiety or other similar/related mental health issues (fear, self-doubt, overthinking...)?

Yes!

No.

What are the biggest issues you're looking for help solving?

Debilitating anxiety.

Overthinking and catastrophizing.

Self-doubt and self-esteem issues.

People pleasing and unhealthy boundaries.

Focus, productivity and executive funcitioning issues.

Lack of motivation.

General fear, dread and a uneasy feeling.

(OPTIONAL) Tell me a bit more about what you're dealing with and how it's affecting your life and/or career.

Which of the following best describes you? (Be very honest, trust me…) *

I’m looking for world-class help and am ready and willing to invest whatever it takes to get it.

I'm nervous about investing money in a solution, but if I truly believe I've found the answer to my pain, I'm willing to be resourceful to make it happen.

I'm desperate to solve this but have absolutely no resources. I can't invest in a solution, no matter what, even if it would save me.

I don't see this as a major problem. I'll take free help if I can get it but I'm not willing to invest much time, energy or money in solving it right now.

Last question: How soon are you committed to make this change? *

RIGHT NOW - I want to get started immediately.

WITHIN 90 DAYS - I have other things to attend to first.

MORE THAN 90 DAYS - I want to do this eventually but I’m not sure when.

PLEASE UNDERSTAND: I am a real person, setting aside time in my day to speak with you because you're asking for my help. I'm honored to do it, but please be respectful. Please put this call in your calendar right away and commit to showing up. And let me know if you're not going to make it so I can free up the time on my schedule. Please type I UNDERSTAND below. *

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