Transformational Private Coaching Application

The Application for the TRANSFORMATIONAL PRIVATE COACHING PROGRAM with Simona is confidential. Please fill out all parts of this Application as accurately and openly as possible. It is crucial that Simona gets a clear and authentic understanding of who you are and what you are looking for in order to make a fair decision about accepting you as a new private client. Once we receive your completed Application Form, we will review it and get back to you within 72 hours and schedule your FREE STRATEGY CALL with Simona. Remember, this is confidential, so please be open and authentic.

Names

First Name (required):

Last Name (required):

Partner's Name, if any:

Address Info

Address (required):

City (required):

State/Province (required):

Post Code:

Country (required):

Other Identity Info

eMail (required):

Skype Name:

Facebook Name:

Date of Birth (required):

Please tell us about yourself:

What has inspired you to dive deep within yourself and explore Intimacy Coaching based on Tantra now? (required)

Have you had prior experience with Tantra, Taoism, Yoga, Meditation, Mindfulness, Psychology, Bioenergetic, Breath-work, Healing Arts, Bodywork? If so, with whom, when, for how long and what have you learned? (required)

Why are you a good candidate for a Private Coaching VIP Program with Simona? (required)

If you could change 3 things in your life & relationships over the next 6 months, what would they be, in order of importance? (required)

How do you ideally want to feel in your body and how do you want to experience your humanity, spirituality and sexuality? Explain how that is different from what you are experiencing now. (required)

What do you think is your biggest obstacle in reaching that ideal potential/embodiment? (required)

How would you describe yourself from a sexual, spiritual, psychological and emotional perspective? What are your aspirations and intentions? What are your fears? What are your needs? (required)

Do you have any emotional, physical, psychological or sexual health issues? (required)

Have you ever been sexually, emotionally, psychologically or physically abused? (required)

Briefly describe your relationship with your family? (required)

What is the greatest outcome you would love to see from specifically doing a Private Coaching Program with Simona? (required)

Anything else you would like us to know as we are considering working with you? (required)

Thank you for taking the time and being open and authentic in sharing your deepest self with us.

Love, Simona