Anahata's Quantum Leap 1:1 High Performance Coaching Application

I am 100% committed to YOU throughout this program.
This application determines if YOU are equally committed and whether this program is the best fit for you.

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First Name

Last Name

Email

Mobile Number

Address

Address 2

City

Zip Code

Country

Please answer the questions below, thoroughly yet succinctly. (2-3 sentences max)

What is calling you to this program?

Where do you keep getting stuck? Identify the main struggles you are dealing with right now.

What big shift or change would you like to achieve in your life?

What is at stake if you don't make these shifts?

On a scale of 1 to 10 (10 being a "My Life Depends On This!") How committed are you to completing all 12 sessions of the program, corresponding assignments, and monthly coaching calls? Explain why.

Have you already worked with me previously or attended any of my retreats or programs? If so, please list which ones and when.

What strengths are you bringing to this experience?

Would you be interested in a private weekend intensive with Anahata in Sedona for an additional investment?

Please share, confidentially, if you are on any medications, or been diagnosed with medical conditions or psychological disorders so I can assess how best to support your journey.

Is there anything else you want me to know?

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