DC - Application Form

Curious about 12 Weeks of Healing?

Fill out this application and we will reach out with more information & help you book your Free Discovery Call.

Name

What state/province are you from? Our team works with humans around the world!

How did you find us?

Where do you feel you need the most support?

What are your current symptoms?

What brings you to this type of work within The Simplest Self?

Have you attended therapy or coaching before? What was that like for you?

What are you hoping to learn from this consultation?

Have you read our FAQ from The Simplest Self website?

Are there days of the week that work best for you?

Are you comfortable receiving a call from our Client Care Specialist, Crystal, in the next 24-48 hours to assist with scheduling? (*Please note this call may show up as a 720 area code or Unknown)

What is the best phone number to reach you if there is any issue in contacting you? If you are outside of the US or Canada, please use your Whatsapp number!

Is there anything else you think we should know about you to help best support you?

Curious about 12 Weeks of Healing?

Join Our Free Trial