Are You Interested In NeuroCoaching For Yourself Or Your Team?
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Name
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First Name
Last Name
Phone Number
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Provide your country code if your contact number is other than the United States.
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Email
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Face Time Video Preference
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Dr. Andrea Will Send You A Link.
What are the specific challenges you want to immediately address?
Challenge #1
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Challenge #2
Challenge #3
What would you most like to alter or change about yourself?
Are you familiar with mindfulness practice or meditation? If so, in what forms?
On a scale of 1-10 (10 = very), how satisfied do you feel with your current work?
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On a scale of 1-10 (10 = very), how satisfied do you feel with your professional relationships?
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On a scale of 1-10 (10 = very), how satisfied do you feel with your personal relationships?
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On average, what percentage of time per day do you feel anxious or frustrated?
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What percentage of time per day do you feel sad, lonely, or depressed?
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What percentage of time per day do you feel calm or happy?
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What else would you like to share with me about your life, your goals, your dreams, or your challenges?
Please list 3 potential days or the week and times for Dr. Andrea to respond to your inquiry, based on Pacific Standard Time 6am-midnight in Seattle, Washington, USA https://www.worldtimebuddy.com/
1. Day or Week and the time block you are available to be contacted.
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2. Day or Week and the time block you are available to be contacted.
3. Day or Week and the time block you are available to be contacted.
How did you hear about Dr. A? (Check all that apply)
