Welcome!

I’m so glad you’re here. Taking this step shows your commitment to transformation, and I’m honored to be part of your journey. This short questionnaire will help determine if my services are the right fit for you. Please answer as honestly as possible—there are no wrong answers.

If we’re a good match, I’ll provide guidance on the next steps.

Name *

Email *

Phone *

Which package are you most interested in? *

Single RTT Session (1 session)

Deep Healing RTT Package (3 sessions)

VIP RTT & Coaching Package (12-week program)

Not sure yet, I’d like guidance on the best fit for me

What is your primary reason for seeking support? 13zez *

Have you previously worked with a therapist, coach, or RTT practitioner? *

Yes

If yes, what was your experience like?

How is this challenge affecting your daily life? *

What does a life without this issue look like to you? *

Have you been diagnosed with or experienced any of the following? (Check all that apply) *

Do you take any medications or use recreational drugs? *

Yes

If so, please list here

Are you open to deep inner work, self-reflection, and implementing changes? *

Yes

On a scale of 1-10, how committed are you to making real changes in your life? *

Disclaimer:

By submitting this form, you acknowledge that my services, including coaching and RTT therapy, are not a substitute for medical or psychological treatment. If your condition requires medical intervention, I encourage you to consult a licensed healthcare professional. All information shared remains confidential unless required by law. Results vary based on individual participation and commitment.

Thank you for taking the time to complete this form! If you’re a good fit, I’ll reach out with next steps.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.