Application form

How long you are in this situation?

Just now

Less than a year

More than a year (specify)

What are you struggling with the most?

What is your biggest challenge right now?

What do you need most by now?

If you can let go of one thing from your life, what would it be?

What is your biggest fear?

Are you angry?

What is your anger rate from 1 to 10?

What is the reason for your anger?

What is the specific challenge that you want to solve in our session?

What is your first name?

Last name?

I'd like to send you confirmation for our session, what is your best email address