Name *

First Name

Last Name

Phone *

(###)

###

####

Putting ourselves at the top of our priority list is essential to gaining a clear vision for our lives. What is keeping you from the attention, love and grace you should show yourself? *

Check all that apply.

You have a hard time saying no therefore need to work on boundaries

Relationships that are not good for your mental and emotional health

Putting others needs above your own so you are living in a state of overwhelm and burnout

You have a difficult time with organization and time management

Do you honor your body with movement on a consistent basis? *

Yes

No

How would you best like to work together? *

Check all that apply.

Self-paced program

One-on-one sessions

Community