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Deep Reset Program – Client Discovery Application

This short form helps us tune into your current needs and determine if the Deep Reset is aligned with your healing path. Please answer from the heart—there are no right or wrong answers.

Click the button below to start.

Start

Question 1 of 17

Your Full Name

Question 2 of 17

Phone Number

Question 3 of 17

Time Zone (Select one)

A

PST

B

MST

C

CST

D

EST

E

GMT

F

Other

Question 4 of 17

Preferred Session Times

(Select all that apply)
A

Weekday Mornings

B

Weekday Afternoons

C

Evenings

D

Weekends

Current Life Snapshot

.

Question 6 of 17

 

What areas of your life feel out of balance right now?

Question 7 of 17

 

What limiting patterns or behaviors are you ready to break through?

Question 8 of 17

Have you worked with a healer, coach, or therapist before?

A

Yes

B

No

Question 9 of 17

 

What do you feel is currently blocking you from clarity or peace?

Section 3: Soul Inquiry

.

Question 11 of 17

If you could wave a magic wand, what would your life feel like three weeks from now?

Question 12 of 17

What part(s) of you are asking for a reset?

(Select all that apply)
A

Body

B

Mind

C

Heart

D

Spirit

E

Relationships

F

Career

G

Parenting

H

Other

Question 13 of 17

 

 What’s one message your inner voice or soul has been whispering to you lately?

Section 4: Readiness + Intention

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Question 15 of 17

 Why is now the right time for your Deep Reset?

Question 16 of 17

 

On a scale of 1–10, how committed are you to showing up for this journey?

A

1

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10

Question 17 of 17

 

 Is there anything else you'd like to share before we connect?

Confirm and Submit