Let’s dive deep together

Name *

First Name

Last Name

Phone

(###)

###

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What goals are you interested in working on?

Please Select 3 or less

Managing Anxiety/Stress

Building Confidence/Self-Worth/Self-Love

Habit Eliminating/Changing/Building

Overcoming Fear/Limiting Beliefs

Pushing Past Procrastination

Healthy Relationships (e.g., Attachment Style, Self-sabotage)

Healing Trauma

Uncovering Past Lives (Past Life Regression)

Preferred Date

MM

DD

YYYY