New Client Contact - Religious Harm Recovery

Interested in Working With Me?

Use the form below to get started!

Prior to submitting this form, be sure to check out the FAQ page for the most common questions I receive about insurance and the coaching process.

First & Last Name*

Email*

How did you hear about me?*

Have you reviewed my coaching rates? See coaching rates*

* Please review coaching rates prior to submitting this form.

Do you have availability for sessions on a Tuesday, Wednesday or Thursday?*

* If you have scheduling limitations, please list general availability at the end of this form (include time zone).

What religious group were you indoctrinated into?*

In 2-3 sentences, tell me about the challenges you’re facing related to religious harm:*

*List some general timeframes on a Tues, Wed, or Thur that work well for you (include your timezone):

E.g. Tuesdays from 12pm-3pm, Wednesdays from 2pm-4pm, etc.

What questions or general comments do you have for me? Check out the FAQs