Application for the Relationship Mastery Accelerator Coaching

*The information you provide here is protected as confidential. Note that your submitted application does not indicate acceptance into the Relationship Mastery Accelerator small group coaching.

Your Name(Required)

First Last

Your Email(Required)

Enter Email Confirm Email

Phone(Required)

Preferred Pronoun(Required)

She/Her

He/Him

They/Them

Other

What are the main goals you would like to achieve when joining the Relationship Mastery Accelerator?(Required)

Are you currently receiving counselling, if so, what are the main concerns?(Required)

Do you have any mental health diagnoses I should be aware of? Please describe.(Required)

Have you been suicidal (past or current)?(Required)

Yes

Do you have any concerns about sharing in a small group setting?(Required)

Do you have any questions about the Relationship Mastery Accelerator small group coaching?(Required)