Time to complete this application: ~3 minutes. You don’t need perfect answers; just honest ones.

First Name *

Last Name *

Phone (only if you prefer text reminders; no cold calls)

Email *

How are you experiencing burnout? *

In the last month, where did busywork crowd out your real priorities? *

How have you tried to manage burnout thus far? *

Which best describes your current direction? (choose up to 2) *

Leaving insurance and being private pay

Starting a private practice

simplifying or repairing my current practice

Adding groups/restructuring

Switching to coaching

Leaving the helping field all together

I don't know yet

Something different (please explain below)

If you said something different to the previous question, please share more here

What would your dream work life look like and how does that differ from now? *

Which of my values (kindness, fun, inspiration, growth) is easiest for you, and which will stretch you? *

What would make coaching feel more joyful and not heavy? *

Are you willing to put into practice what we discuss in between sessions? *

Can you commit to weekly 80-minute group sessions for 6 months, plus between-session practice? *

Yes

No

Not sure

If accepted, are you prepared to make an investment in coaching in the next 30 days? *

Yes

No

Need to talk it through

If this mentorship were a perfect fit, what would need to be true for you to say yes? *

What would make this not a good fit right now? *

What’s the cost of staying as-is for 6 more months? *

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Freedom Jumpstart Call Questionnaire

Before you book, please answer a few questions so I can understand what you’re carrying and make sure a call with me is the right next step for you.