It's important that we are the right fit for each other so that I can offer you as much value as possible and guide you to successfully reach the transformation you desire.
👉Please take about 10 minutes to complete this 14-question application form as a preliminary step.
Once you have completed the form, I will reach out to you by email ASAP in order to plan our next steps.
Click the blue button below to begin the application process.
Question 1 of 14
Please type your name.
Question 2 of 14
Please type your date of birth. (MM/DD/YYYY)
Question 3 of 14
What is your gender?
(Sex hormones directly affect breathing, so this is quite relevant to our work together.)
Question 4 of 14
What is your occupation?
Question 5 of 14
What are the primary symptoms/complaints you are looking to address?
(These can be physical, mental, emotional, psychological and/or spiritual in nature.)
Question 6 of 14
What are your short-term goals regarding your overall health?
(What/how would you like to transform within the next month?)
Question 7 of 14
What are your long-term goals regarding your overall health?
(What/how would you like to transform within the next year?)
Question 8 of 14
On a scale of 1-10, how committed, compliant and dedicated are you to achieving these goals?
1 = not committed, compliant, dedicated at all
10 = extremely committed, compliant, dedicated
Question 9 of 14
Private coaching starts at $200 per session and I require a minimum of 3 sessions. Are you in a financial position to comfortably afford private coaching?
(Due to my limited capacity to accept 1-to-1 clients, I must prioritize individuals who are ready to make changes in their daily habits and who can afford my services. If you cannot afford private coaching, please let me know and I will happily suggest other options to you.)
Question 10 of 14
Have you ever done any type of breathwork before? If so, what type and how often?
Question 11 of 14
Have you ever had a negative experience with breathing? If so, please explain.
Question 12 of 14
Why are you interested in working with me specifically?
Question 13 of 14
Where are you located?
(This is relevant for communication and scheduling. I am located in Eastern Time, just outside of NYC.)
Question 14 of 14
Please type your email address so that I can follow up with you ASAP.
⭐(Please use an email address that you check frequently and please be sure to add [email protected] to your safe list. I typically respond within 24-48 hours. If you don't see my response show up in your inbox, be sure to check your junk/spam folders.)