Rejuvenation Application

Take a few moments to reflect before you answer - there's no right or wrong here. These questions are designed to help both of us understand what's working for you right now - and what's quietly asking for your attention.

First name

Last name

What made you take the 'What's Draining You' quiz today?

Briefly describe what's been most draining

What do you believe has been holding you back from achieving your goals until now?

On a scale of 1–10, how ready are you to make changes in your life right now?

What support do you feel like you're lacking?

Have you worked with a coach, mentor, or counselor before? If yes, what was the outcome?

Are you open to exploring one-on-one or group coaching support?

Yes

If you discovered a path that could help you reconnect with the real you, would you be ready to take the next step now, or do you need more time to reflect?

I'm ready now

I'm close, but I need a little clarity

I'm not ready yet

In addition to the financial investment, what emotional and time investments are you willing to make for coaching?