Remove Heart Blocks Signature Program — Application

Thank you for your interest in the Remove Heart Blocks Signature Program.

This is an intimate, high-touch coaching container designed to help you release emotional blocks, reconnect with your heart, and create a life aligned with your values and desires.

To maintain the integrity of this work and ensure each participant is a great fit, please complete the application below with honesty and openness.

First Name *

Last Name *

Phone *

Email *

What inspired you to apply for the Remove Heart Blocks Signature Program at this time?

What is the biggest emotional or life challenge you’re currently facing?

On a scale of 1–10, how committed are you to making real, lasting changes in your life over the next 90 days?

1–3 Not very committed

4–6 Somewhat committed

7–8 Very committed

9–10 All in — I’m ready for major transformation

Please explain your rating:

Have you ever worked with a coach, therapist, or mentor before? What was that experience like for you?

The program requires personal introspection, emotional honesty, and the willingness to try new tools like EFT tapping, somatic practices, and NLP reframing. Are you willing to fully engage in these modalities?

Yes

No

Not sure

What are the top 3 outcomes you desire from this program?

What tends to get in your way when you try to grow, heal, or follow through on personal development goals?

High-level coaching requires time, focus, and energetic investment. Are you able to commit 60–90 minutes weekly to your healing and growth?

Yes

No

I can with some adjustments

This is a high-ticket coaching program. If accepted, are you prepared to make a financial investment in yourself and your transformation?

Yes, I invest in myself when something aligns

I’m resourceful — if this feels right, I’ll find a way

Not right now

Why do you feel you would be a powerful fit for this program?

Is there anything else you’d like me to know as I review your application?

Your Invitation to reconnect with your heart

You Don’t Need Another To-Do List. You Need to Feel Again.

Not sure where to start?

I invite you to take a moment for yourself and book a free 30-minute call.

During this time, we will explore what your heart truly needs and how I can support you on your healing journey. Together, we will uncover the path to greater clarity, peace, and confidence.

Your heart is ready—let’s listen to it together.