Worksheet

Life Boost Program Application

My Life Boost programs are designed to help you to start experiencing life in a new way that feels so much gentler, kinder, empowering, fulfilling, and energizing as you create the change you want. That means the first step of signing up for one of my programs should feel like a weight is being lifted off your shoulders. This application is to make sure one of my programs is the right fit for you in this season of life and so that I can address any questions you have prior to getting started.

1. ➜

Name

2. ➜

Date

3. ➜

Email

4. ➜

Tell me about yourself. What challenges are you experiences and what do you want to be different?

5. ➜

Why are you interested in working together?

6. ➜

What do you hope to get out of the Life Boost program?

7. ➜

Which Life Boost program are you interested in? Check all that apply.

You can learn more about my programs at www.lifeboost.today/lbprograms.

3 month Game Changer

6 month Life Boost Mentorship

6 month 1-on-1 Program

I'm not sure - I'd like to discuss what would be the right fit

8. ➜

Transparency is important to me. Let's talk about how you feel about making this investment in yourself.

Program Prices:

3 Month Game Changer - $1000 or $360/month
6 Month Mentorship - $1800 or $330/month
6 Month 1-on-1 - $3960 or $760/month

I am ready to make that investment in myself, because I am ready for change and know the ROI will be worthwhile.

It feels like a stretch/feels out of my comfort zone, but I'd like to talk through it.

I'm not ready to invest that much in creating the change I want. (If this is the case, the self-love month or one of my free resources will be the best place to start

9. ➜

I am ready to commit to at least 10-15 minutes per day on me during this program.

Yes, I am ready to make myself a priority.

I want to be, and I will use the support and resources in the program to help me to make it a habit.

That feels really intimidating/hard right now. (If that is the case, self-love month is the perfect place to start!)

I don't know, but I want to talk through it and to learn more about what that would look like.

10. ➜

What questions do you have?

11. ➜

How did you find out about me?

13. ➜

Have you been diagnosed with a mental health condition?

While my programs dive deep into understanding your nervous system, mind, and body from a holistic perspective, they are not a substitute for working with a licensed therapist. As a coach, I am not here to help you to "treat" anything or to "fix" yourself. Your body has so much wisdom. I am here to help you to look beyond any diagnosis so that you can look at your whole self. My programs are designed to help you to get curious about and to explore why you do/feel the way you do so that you can feel empowered with an understanding of how your unique body and mind work in order to navigate life in a way that feels like a breath of fresh air.

With that said, if you have been diagnosed with a mental health condition I require a referral from your therapist or psychiatrist before working together. It can be emailed to amelia@lifeboost.today.

Yes and I will get a referral

Yes but I am not currently working with a licensed therapist or psychiatrist

No but I am concerned that I may have one

No I have not been diagnosed with a mental health condition

14. ➜

Are you ready for a holistic approach that's going to feel like a breath of fresh air?!

Yes!

I want to be and I'm excited to talk more.

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Life Boost with Amelia