Clarity Call Application

First Name *

Last Name *

What do you prefer to be called?

Email *

How did you hear about me? *

What is your biggest struggle right now and how long has it been going on? *

Have you tried anything to resolve this problem or challenge? *

If you answered yes, what work have you done toward this problem or challenge?

On a scale from 1-10, how important is it to you to get this resolved? *

Are you in a place to invest in yourself to get the support you need to address your frustration and get it resolved? *

What days/times work best for you? *

If you got a chance to look over my program offerings, which one appeals to you the most? *

Is there anything else you'd like to share with me?