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Mind-Body Workshop

Coaching Application

Share a little about yourself by filling out this quick form. We’ll review it carefully to make sure this coaching experience is the best fit for you

First Name *

Last Name *

Phone *

Email *

Occupation *

State *

Please tell me where you are in your healing journey. *

I am at the very beginning of my healing journey.

I've already done some healing work.

I've done a lot of healing work, but I'm ready to explore more.

What are you struggling with the most? (Choose up to 3) *

Nervous system dysregulation

Irritability with kids/family

Anexiety/Depression

Panic

Worry/fear

Betrayal

Unforgiveness

Anger

Shame

Boundaries

Grief

Codependence

Stress/overwhelm

Fatigue/exhaustion

Chronic pain

Sleep disturbances/insomnia

Hormone imbalance

Gut issues

Skin issues

Other physical symptoms

Other

In as much detail as possible, please describe what you hope to gain from the Rooted-Rewired-Restored program. *

What is your biggest obstacle in achieving your health goals? *

How committed are you to your healing? *

1 (not very committed)

5 (extremely committed)

How much do you believe it’s possible for you to experience true freedom and healing? *

1 (not much belief)

5 (full belief)

Which statement resonates most with you today? *

I feel like my past defines me

I feel like I am sometimes controlled by my past

I feel like I am actively healing and reclaiming myself

I feel like I am aligning more with who Christ created me to be

I feel like I am fully living in my Christ-given identity

What coaching option are you applying for?

Tier 1: Rooted-Rewired-Restored 1:1 Program ($997/mo for 6 months or $1297/mo for 3 months)

Tier 2: The Freedom Collective ($777/mo for 3 months)

Tier 3: Rooted Woman Membership ($37/mo)

How did you hear about me? *

Anything else you'd like me to know?

Guiding women to freedom and holistic wellness through faith-integrated mind-body health.