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1:1 Neuro Coaching

I am offering a 50% DISCOUNT on 1:1 Neuro Coaching!🥳

👉Please take about 10 minutes to complete this 12-question application form as a preliminary step and to learn more about the discount.

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.

(PLEASE NOTE: You cannot save your answers and return to them later. Please be sure you have about 10 minutes to complete and submit the form.)

Start

Question 1 of 12

Please type your name.

Question 2 of 12

Please type your date of birth. (MM/DD/YYYY)

Question 3 of 12

What is your gender?

 

(Sex hormones impact your nervous system, so this is quite relevant to our work together.)

Question 4 of 12

What is your occupation?

 

(This impacts your posture, movement patterns and breathing mechanics.)

Question 5 of 12

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 12

What are your short-term goals regarding your overall health?

 

(What/how would you like to transform within the next month?)

Question 7 of 12

What are your long-term goals regarding your overall health?


(What/how would you like to transform within the next year?)

Question 8 of 12

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 12

I am offering a 50% DISCOUNT on 1:1 Neuro Coaching, so instead of USD $200 per session, I am only charging USD $100 per session.

 

In return, I am asking for a commitment of 8 sessions, spread out over 2-3 months. That's an initial investment of USD $800.

 

 

 

👉If you are in a financial position to comfortably afford this, please type "yes" below.

 

OR

 

👉If you are very interested in neuro coaching and committed to your goals, but cannot afford the USD $800 investment, please type what you can reasonably afford below. (I am willing to work on a sliding scale, within reason.)

Question 10 of 12

Why are you interested in working with me specifically?

Question 11 of 12

Where are you located? 

 

(This is relevant for communication and scheduling. I am located in Eastern Time, just outside of New York City.) 

Question 12 of 12

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.)

Confirm and Submit