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Regain Your Core™ Coaching Application

Thank You for Your Interest in the Regain Your Core™ Coaching Program!

You’re here because you desire to reclaim your authentic self and embrace the woman you’re meant to be. We’re honored that you’ve considered us to be part of your journey!

This application is an important step and includes several questions, including ones related to mental health, to help us determine if we’re the best fit to support you. Please take your time to complete the application thoroughly. We deeply value your privacy, and the information shared will be handled with care and confidentiality.

If we require additional details, we’ll contact you using the information you provide. Kindly note that incomplete applications will not receive a response. 

We’re excited to review your application and hope to work with you!

Click the button below to start the application.

Start

Question 1 of 10

First & Last Name

Question 2 of 10

Telephone & Email

Question 3 of 10

What do you hope to achieve from participating in Regain Your Core™, and why is achieving this important?

Question 4 of 10

Please share why you believe Regain Your Core™ is a good fit for you.

Question 5 of 10

What are the most significant challenges you’re currently facing, and what personal strengths, skills, or traits do you believe will help you overcome them?

Question 6 of 10

In the past twelve months, have you experienced thoughts of self-harm or suicide? If yes, please share what support you have received or are currently receiving to address these challenges.

Question 7 of 10

Have you been diagnosed with a severe mental health condition, such as major depressive disorder or bipolar disorder? If yes, please share any relevant details you feel comfortable disclosing.

Question 8 of 10

Are you currently working with a psychotherapist or psychiatrist? If yes, please share whom you're working with and the main focus of your work, if you're comfortable sharing.

Question 9 of 10

Which program are you applying for?

A

Group Coaching (Regain Your Core Tribe)

B

1:1 Coaching

Question 10 of 10

Please include any additional information here that you believe is important for us to know.

Confirm and Submit