Contact

Contact Form
Please fill out the form below and I will contact you at my first available opportunity.
Please note: All sessions are active and done by phone, and requires a hands free device for freedom of movement (no speaker phones please).
Sessions are also available via Skype (for those outside the U.S.A.) and also requires a headset.
If you are not sure what services would best help you accomplish your goals, I do offer a complimentary 30 minute consultation.

Name *

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Email *

Phone: *

How would you like to be contacted? *

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If by phone, when is the best time/day to reach you to schedule our initial consultation? *

Where are you located? *

How did you find this site? If referred by someone, who referred you? *

What services are you interested in? *

If other, please explain: *

What is the primary goal/intent you are seeking to change with coaching/hypnosis? *

On a scale of 1 to 10, how committed are you in actively participating in the accomplishment of your goal/intent? *