Coaching & Support Application

Aloha 🩷

I know you must be feeling pretty crappy right now, I feel you. The good news is, you don't have to any more.

Congrats for taking a step toward long-term JOY and better health. This form should take 5-8 minutes to fill out to make sure we are a good fit before a chemistry call can be booked.

Remember, I specialize in post-crisis and post-rehab coaching, not therapy, medical care, diagnosis, psychiatric care, detox services, legal nor financial advice.

**** If you are in danger, experiencing a medical emergency or withdrawal symptoms, or feel you might harm yourself or someone else, call 911 or 988 or go to your nearest ER.

By submitting this form, you understand this is an application for coaching, and you are responsible for your medical and mental health care with licensed providers.

🔒 Confidentiality Promise

Your answers will only be seen by me.

I will never share what you write without your permission, except where required by law or if there is an immediate safety risk.