Client Application:

Thank you for being here. I'm so grateful to connect with you. If you’re interested in working together, your first step is to complete the form below.

There are no right or wrong answers. All I ask is that you answer honestly and share as much information as you feel comfortable, so that we can make sure we are a good fit and I can meet your needs.

After you complete and submit this application, I (or my team) will review your responses and reach out to you for more information.

*Please complete this application ONLY if you are serious about working with me. I have a limited number of spots, so it's important that this application is reserved for those ready to start if accepted.*

Name

First Name

Last Name

Phone

(###)

###

####

Pronouns

Age

How did you hear about us?

Tell me about yourself (hobbies, passions, career, goals, lifestyle etc)

What gets you excited, what inspires you, what lights you up? Get as specific as you'd like!

What inspired you to reach out?

What's your main motivation for wanting to work with Dez? What draws you to her approach?

If we should work together, what's your ideal outcome for you? What would you most like to get out of our work together?

What do you feel are your biggest barriers? What has held you back from getting to where you want to be?

Have you worked with a coach or therapist before? If so, how was that experience? What worked and/or didn't work?

Why is NOW the right time to make this commitment?

Do you have any medical or mental health conditions that might impact our work together?

Yes

If Yes, please elaborate.

Do you understand that you are applying to work with Dez in a coaching capacity and that if you have any mental health needs that take precedence over your coaching goals, you will be referred out to a licensed therapist for mental health treatment?

Yes

This work requires your emotional, financial, physical commitment to staying consistent, showing up and committing to yourself with patience and compassion. Are you ready to make this commitment to yourself and the process?

Yes

On a scale of 1-10, how ready are you to invest in your personal growth?

I recommend setting aside 3 hours per week to work on the somatic practice you will be learning with Dez. Are you able to commit that amount of time each week?

Yes

When do you want your program to begin?

YYYY

Is there anything else you want Dez to know?

Client Application:

Helping Fierce Women Find Soft Power

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