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Love & Purpose Application

WELCOME

Take your time with this application. This is a big step. Really sink into each question, and let the words flow. Once your application is received, we will contact you to schedule an enrollment call. 

Start

Question 1 of 12

Name

Question 2 of 12

Email Address

Question 3 of 12

How did you hear about this program?

Question 4 of 12

What's your deeper WHY for doing this?

Question 5 of 12

Please share if you have or have had any significant mental health challenges in your life. Please particularly note any major psychotic events or similar. (This information will remain confidential.)

Question 6 of 12

Are you currently on any medications ? (if yes, please list them)
 
 

Question 7 of 12

Are there any other needs that you want to share? (mobility, hearing, eye-sight, language)

Question 8 of 12

What experience do you have (if any) of therapy, coaching work, and/or transformational retreats/programs?

Question 9 of 12

Please share as much as you are comfortable about your major life events. Particularly share any recent events -- deaths, break ups/make ups, trauma, business/career changes or other emotional transitions.

Question 10 of 12

What are your biggest concerns about participating in this program?

Question 11 of 12

Love & Purpose is a $2,500+ program. Are you ready to make that level of investment in yourself and your relationship?

A

Yes

B

Yes, but I'll need a payment plan

C

I need to talk about it with Yosef

Question 12 of 12

Anything else you'd like to share that hasn't already been mentioned?

Confirm and Submit