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Come to Rise Application

This 90-day high-level program is for men & women who have left an abusive relationship and are looking to heal, move on and create the best life. In this 1:1 coaching program, you will work through the issues that are affecting you from your past relationship and your new normal. Please fill this out if you are ready to commit to taking your life to the next level.

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Question 1 of 14

What is your first & last name?

Question 2 of 14

What is your best email?

 

Question 3 of 14

Where do you live & time zone?

Question 4 of 14

Have you been involved in an abusive relationship? 

A

Yes

B

No

C

Not sure

Question 5 of 14

Do you think your partner is (or could be) a narcissist?

A

Yes

B

No

C

Not Sure

Question 6 of 14

What is your biggest struggle right now?

A

No self-love

B

I don't even know myself

C

I still miss him/her

D

I feel lost and broken

E

Other

Question 7 of 14

Add more details here...

Question 8 of 14

If you could wave a magic wand and have ANYTHING you wanted in your life, what would it be?

Question 9 of 14

On a scale of 1-4, how would you describe how you feel on a daily basis?

A

1

B

2

C

3

D

4

Question 10 of 14

What do you think are the factors for feeling like this right now?

Question 11 of 14

What's missing from my life is a sense of ________.

Question 12 of 14

Have you worked with a coach in the past? If so, what was that experience like for you?

Question 13 of 14

Are you working with a coach now? If so, what type of coach and what are you working on right now?

Question 14 of 14

Do you have any questions you'd like for me to go over with you?

Confirm and Submit