First & Last Name
Email
Phone Number
What prompted you to reach out at this point in your life? (What feels misaligned, incomplete, or ready for refinement?)
Which areas of your life feel most in need of elevation right now? (Select all that apply) Identity & self-leadership
Body, health, or energy
Confidence, boundaries, or standards
Relationships or relational patterns
Career, business, or leadership presence
Money, wealth identity, or financial relationship
Lifestyle design, structure, or clarity
Something else (please specify)
How would you describe your current season? (Steady but unfulfilled, successful but disconnected, in transition, rebuilding, redefining, etc.)
What does a "wealthy life" mean to you at this stage of your life? (Not aesthetically—but experientially.)
What have you already tried to create change or growth in this area? (Programs, coaching, therapy, self-study, etc.)
What’s no longer working—no matter how “successful” it looks on paper?
If nothing changed over the next 12 months, what would concern you most?
When you imagine feeling fully aligned, grounded, and self-led—what would be different in how you move through your life?
What kind of support are you most drawn to right now? (Choose what resonates most) Strategic mentorship and guidance
Identity, confidence, and self-standards work
Body-based or wellness-focused support
Integrated life & leadership refinement
I’m not entirely sure - I just know I need support
How would you describe your readiness for change? I’m exploring and gathering information
I feel ready but want clarity on the right path
I’m committed to making meaningful shifts now
Have you worked in a high-touch, mentorship-style container before? (Yes / No — If yes, what worked or didn’t?)
Is there anything you feel is important for me to know before we speak? (Context, constraints, goals, or intentions.)
Is there anything else you believe is important for me to know as I review your application?
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