Provide InformationFirst Name* First Email*The scheduling confirmation will be sent to this email. Enter Email Confirm Email Phone*Include area code or any other prefix It's okay to send me booking notifications via SMSHave you ever worked with a life coach before?*YesNoWhat is the biggest challenge you’re facing in your life currently*If you could wave a magic wand and have everything you wanted right now, what are 3 things you would want to have happen?*Are you under the care of a physician or psychiatrist?*YesNoAre you currently taking any medication such as anti-depressants, or anti-anxiety medication?*YesNoHow long have you struggled with your issue or issues?*What have you done so far to address this issue(s)? What has worked and what hasn’t worked?*On a scale of 1-10, how open are you to having your life change?*(with 1 being not very open, to 10 being heck- yeah, I’m ready to change now)12345678910 Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.