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✨ NLP Breakthrough Application

Let’s get you unstuck and into the best version of yourself.
This is your first step toward a true transformation — not just feeling better, but breaking the cycles for good.  This will help me get to know you better before our first call together.

Fill out this assessment if you've booked:

- Your discovery call with me (to see which option best fits your needs)

- Your breakthrough session (Single transformational 60-minute breakthrough session)  /or / 

- The full breakthrough package (6 powerful 1:1 NLP coaching sessions with me (60 mins each), where we’ll go deep and create lasting shifts emotionally, mentally, and somatically. 

Take your time with these questions — answer from your truth. This is your moment to pause, reflect, and get real about what’s not working and what’s ready to change. I’ll review your answers before we book our consult.

Your breakthrough starts here!

Start

Question 1 of 15

Name & E-mail Address

Question 2 of 15

Are you ready to do what's required of you to break old patterns and finally get the life you want and totally deserve?

A

Yes

B

No

Question 3 of 15

What challenge, pattern, or issue brought you here? What keeps coming up that you're DONE dealing with? (Please also indicate any medication or diagnosis you may have, if any)

Question 4 of 15

What have you already tried to solve this — mentally, emotionally, or physically? (Include anything you’ve explored — books, therapy, medication, coaching, etc.)

Question 5 of 15

On a scale of 1-10, how big of a problem does this feel like right now? (1 = minor annoyance, 10 = massively affecting your life)

A

1

B

2

C

5

D

10

Question 6 of 15

If we waved a magic wand and this challenge was fully resolved, what would your life look and feel like 30 days from now? (How would you show up differently? What would be possible? What could you do that you cannot do/have now?)

Question 7 of 15

What would be a sign that things are changing for the better? (Let’s get specific — what would you see, hear, feel, or do differently?)

Question 8 of 15

Which one best describes where you’re at right now?

A

I’m hoping someone can tell me what to do to fix this

B

I’m open to guidance and willing to take small steps

C

I’m fully committed and ready to do what it takes (even if I’m scared)

Question 9 of 15

Three things are required to make change. Please check all that you are willing to do to improve your situation.

(Select all that apply)
A

Focus (I will help you focus in a way that produces positive results by default)

B

Action (I asked about your willingness to take action in a previous question)

C

Resolving of negative emotion

Question 10 of 15

Are you willing to do what is necessary to break free from past negative emotions that are holding you back?

A

I prefer to leave the past in the past and do not want to revisit it.

B

I realize that a positive future comes from an understanding and reframing of the past.

Question 11 of 15

When would you ideally like to start?

A

ASAP

B

In the next month

C

1–3 months from now

D

Not sure yet

Question 12 of 15

What are you willing to invest in your transformation? (Insurance doesn’t cover NLP work)

A

Not ready to invest at this time

B

Up to $2000

C

Over $2000

Question 13 of 15

Is there anything about your family, relationships, or current life situation that you think I should know to best support you? (Ex: kids, relationship status, support system, etc.)

Question 14 of 15

Tell me about your current work or career path — anything you want to share around stress, satisfaction, purpose, or burnout. (Or if you’re in between, that’s okay too!)

Question 15 of 15

Why now? Why is this the moment you’re choosing to change this — instead of waiting another year?

Confirm and Submit