Application Form

Yes, I want a complimentary consult!

To live a fulfilling, vibrant and joyful life requires a commitment to yourself and your outcomes. You are responsible for your success. I can help you break free of your patterns and programming so you can create the empowering and delicious life that is your birthright. I can give you a road map to get you there but you have to be ready, committed and willing to put in the time and resources to make it happen.

This application is simply designed to help me understand if you'd be able to apply the strategies that have helped my clients lose pounds, boost their energy, heal unresolved wounds and consistently experience more love and joy from life. I want this to be a good fit for both of us!

Are you’re ready to step into the best path of your life?

Please complete the questionnaire fully so that I can see if I can help you transform your life!

* Indicates required field

Name *

First

Last

Email *

Phone *

What is going on in your life right now that makes you want to speak to me? *

What is your current health status? *

Please tell me what you currently eat for breakfast, lunch & dinner *

If nothing stood in your way, what would be the #1 physical, emotional and spiritual changes you’d like to make in the next 3-12 months? *

What has been your greatest challenge in making these changes *

What healing therapies do you use? *

What do you tell yourself about your body, your health and your overall life? *

At what point in your life did you feel your best & why? *

What's the biggest challenge you've overcome in your life? *

What feels incomplete in your life right now and really needs to be handled immediately? *

How much are you willing to invest (time, energy & money) in making a change? *

Is there anything you would like me to know for this complimentary session? *

Submit

Yes, I want a complimentary consult!

© 2019 Beautifully Empowered.​ All rights reserved

© 2019 Beautifully Empowered.
All rights reserved