Your Name (required)

Your Email (please use the same email as when scheduling)

Your call preference
Phone callVideo Chat on Zoom.us

 
Your phone number

What are the top 3 things that you need and want to change in your life ASAP? And why?

Are you able to commit to allocating a prime portion of your day for the next 8 weeks toward this endeavor?
Do you have a connection to a Higher Power? If so, describe. If not, are you willing to cultivate such a connection?
Do you feel that you have an empty space in your heart that keeps you from feeling true love? Please describe.
How urgent is it for you to fill this deficit and experience a higher love in day-to-day existence? Please explain.
Are you ready and willing to make radical consciousness transformation a Top Priority in your life?
If you are accepted, are you able to commit financial resources to invest in reaching the goal of higher consciousness and a life filled with joy NOW?YesNo