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FILL OUT THIS APPLICATION TO BEGIN

Name

First Name

Last Name

How would you describe yourself? Give it your best shot.

What is your intention for our time together? Why do you want to work with me specifically?

Describe your dream life. What does it look like and how does it feel?

What current blocks are you experiencing and what have you tried so far?

Please post your social media & website (if applicable) details below:

What do you do for work and how fulfilled are you with what you currently do?

Are you currently on any medications that interfere with your state of mind, energy levels, productivity, concentration or ability to achieve your intentions?

Do you have a current mindfulness practice? If so, please detail.

If you could wave a magic wand, what would your life look like and feel like?

Are you willing to show up and make the changes? What will you say to yourself when things become challenging?

Are you currently in a financial position to pay for this course?

Investment is $1,800NZD for 12 weeks if paid in full with payment options available. Select how you intend to pay below.

1 x Payment of $1,800NZD

3 x Monthly Payments of $600NZD

6 x Monthly Payments of $300NZD

VIP Upgrade: 1 x Payment of $2,200NZD

VIP Upgrade: 4 x Monthly Payments of $550NZD

VIP Upgrade: 8 x Monthly Payments of $270NZD