Empowered Application Form

This questionnaire helps us both determine if we're a good fit.

Please answer honestly - there are no wrong answers, just clarity about whether this programme is right for you right now.

About You:

First Name

Last Name

Phone *

Email *

City *

About Your Business:

What do you do? (Brief description of your business):

How long have you been in business?

What is your current annual business revenue? (This helps me understand where you are and ensure the programme is right for your stage)

What specific problem brings you here today? What's not working in your business right now?

Which of these resonates most with you right now? (Select all that apply)

Other...

What have you already tried to solve this problem?

About Your Readiness:

If we work together, what would success look like for you in 3 months? (Be specific - what would be different in your business? Your life?)

Are you willing to do deep inner work (hypnotherapy, somatic practices, facing limiting beliefs) to create change?

Are you prepared to invest £3,000 (or 2 x £1,500) in your transformation over the next 3 months?

Final Questions:

What made you apply for EMPOWERED? Why now?

Is there anything else you'd like me to know before our call?

What's your availability for a discovery call? (Select your timezone and general availability):

By checking this box, I consent to receive email replies, marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Reply HELP for help or STOP to opt-out.

I have read and agree to the Terms and Conditions and Privacy Policy - links found a the bottom of the page.

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