The Clarity + Action Intensive Application

First Name *

Last Name *

Phone *

Email *

How did you hear about us? *

About You

What’s your current role or primary focus right now?(Entrepreneur, executive, caregiver returning to herself, etc. Anything you want to share.) *

How does ADHD show up in your life at the moment?(Share anything you feel comfortable with — patterns, roadblocks, frustrations, or situations where you get stuck.) *

Your Goals + Challenges

What are the top three things you want support with over the next 12 weeks? (Examples: follow-through, routines, emotional regulation, prioritizing, time-blindness, systems, energy management, confidence, etc.) *

How do these challenges impact your daily life, work, or relationships? *

If our work together were successful, what would feel different three months from now? (Be as specific as you’d like — clarity, steadier habits, less overwhelm, better decision-making, etc.) *

Fit + Expectations

What type of support do you feel helps you follow through best? (Structure, accountability, clarity, breaking things down, emotional support, strategy, etc.) *

Have you worked with a coach before? If yes, what worked well — and what didn’t? *

Is there anything else you’d like me to know? (Anything about timing, concerns, hopes, or how you like to be supported.)

Readiness + Capacity

On a scale from 1–10, how committed are you to making meaningful changes during this program? (1 = “I’m not ready to make any changes right now.” 10 = “I’m fully committed and willing to take consistent action with support.”) *

1
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How much are you realistically prepared to invest, in total, in private coaching support over the next few months? (Please choose the range that feels accurate for you right now.) This question helps ensure we’re aligning you with the right level of support. *

$5,000+
$4,000 – $4,999
$2,500 – $3,999
$1,000 – $2,499
Under $1,000
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If you’re accepted, when would you be ready to begin? *

Immediately
Within 2 weeks
Within 30 days
I’m gathering information for the future
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