Application Form

I am very selective as to whom I dedicate my time and energy within the coaching process, taking on only a select number of clients annually in the private coaching/ mentoring format. 

One of my core values is to only work with people that are committed and interested in supporting their own healing and contributing towards global change by raising their vibration and that of others around them. 

As such I have created this application process to enable me to fine tune the ideal clients to work with me and for you to also discern if our values align in the coaching process. 

As a Holistic Health Coach my goal is to support you to not only heal but to grow! 

If you are willing to grow, become accountable, spend time on the inner work and are open to shifting your old paradigms, limiting beliefs and habits that are holding you back, then please complete this application form 

Fields marked with an * are required

First Name *

Last Name *

Email *

Occupation *

What programme are you interested in joining? *


What is the main challenge you want help resolving at this point in your life? *

What makes you feel this methodology of coaching is the right approach for you? *

What have you tried in the past to alleviate your concerns? *

What's your biggest obstacle or frustration you're encountering? *

If I offered you the exact steps to change the aforementioned concerns/obstacles, how committed would you be? *

What's high energy, mental clarity, more time and freedom worth to you? *

What questions/reservations do you still have? *


Thanks for submitting!