One-on-One Program Application

If you prefer to download the pdf application and fill it out that way, click here.

Once you have submitted the form, I will review it and contact you. Please allow up to 2 full business days for a response.

First Name(required)

Last Name(required)

Email(required)

Phone Number(required)

Skype Name(required)

Website (If you have one.)(required)

State/Country/Time Zone(required)

Do you currently hold all necessary licensure, certification, school hours, etc. to legally practice massage therapy where you are?(required)

Yes No

Why do you want participate in this one-on-one program?(required)

What attracts you to working with me specifically?(required)

Do you already have a private practice? (It's ok if you don't.)(required)

Yes No

If yes, is your practice full-time?(required)

Yes No Not applicable

Describe your current practice (if you have one). Please include any specialties or your particular areas of interest.(required)

How many active clients do you currently have? (It's ok if you don't have any.)(required)

How long have you had your practice?(required)

What do you want out of your practice? (Please be as lengthy as needed.)(required)

Do you feel that you currently treat your practice as a business? (Or is it more of a hobby or a fly-by-the-seat-of-your-pants kind of a thing.)(required)

What do you think is your biggest obstacle to having the kind of practice you want?(required)

Where do you think you are getting stuck or stopped in reaching your goals?(required)

What other business building or personal growth programs have you taken?(required)

Why is it meaningful to you to be a part of this program?(required)

Will paying for this program be a problem for you? (Reminder, the cost is $2,500 or $1,500 down and 3 installments of $383.)(required)

What is your level of dedication to building your business into a full practice? (1-10 scale, 1 is lowest)(required)

What is your biggest hope for what you would get from working with me one-on-one?(required)

Any additional comments or questions as I consider your application?(required)