Private Coaching Application


This application serves as my first introduction to you, so take your time and be as specific as possible.
Please fill out all questions below before submitting for your free discovery session.
Name *
(Examples: A friend, YouTube, Social Media, etc)
For this question and every question I ask you, don't give me the "right" answer. Give me the truth.
Coaching is a significant investment of your time, money, and energy. You'll get from it as much as you give. Are you willing to stretch out of your comfort zone and embrace positive change in your life?
The conversations that we have within our coaching sessions are confidential and will be protected as such. You agree to not record me in an audio or visual format unless you have received written permission. You also agree not to distribute any original material from me unless you have received written permission. Information will be shared by me outside of our sessions only with your written consent or in the event that a Court Judge demands it, however, the following are instances where I would be obligated by law to break our confidentiality agreement without your permission: If it is assessed during your participation in coaching sessions that abuse or neglect of children or elders is occurring. If in my presence you threaten to kill or harm another individual, and I am convinced that you will act on this threat, or that you may lose control of your actions. If at any time during the course of our sessions, I determine that you are a danger to yourself, I will inform you of that opinion and make every effort to keep you from endangering your life. In some cases, this may include notifying the police or family members.