Request for Consideration: Executive Wellness Program

This is a private, limited-availability executive wellness engagement. Please complete the request below. If you’re a fit, you’ll receive next steps.

Note: This is not therapy, medical care, or mental health treatment.

Full Name *

Email *

Phone

Company / Organization

Role / Title *

Location / Time Zone *

What is the primary outcome you want from executive wellness support? *

What are the biggest performance or stress challenges you’re facing right now? *

What high-stakes responsibilities are on your plate in the next 30–90 days? *

What type of support are you looking for? *

Your availability for sessions (days/times) *

What have you tried before (coaching, wellness, systems) — and what didn’t work? *

Investment readiness *

Why now? What makes this a priority? *

Anything else you want me to know?

I understand this is an application-only request. If accepted, I will be contacted with next steps. *

Limited availability. Not all requests are accepted.