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Path to Empowerment Application

Before You Begin

Thank you for your interest in Path to Empowerment.

This short application helps ensure the program is the right next step for where you are in your healing journey.

Your responses are confidential and there are no right or wrong answers. If you feel unsure about any question, that is completely okay. We can explore it together during your call.

Once you submit the form, you will see a link to the scheduling page to book your Clarity Call.

Click the button below to start.

Start

Question 1 of 10

1. Please select your call preference. 

A

Video Call

B

Phone Call

C

WhatsApp

Question 2 of 10

2. Have you worked with a coach, therapist, or support program before? 

If yes, what felt supportive or unsupportive for you? 

Question 3 of 10

3. In what ways do you feel your past experiences are still affecting you today? 

Question 4 of 10

4. Are there areas of your life where you feel stuck or unsure, even if you can’t fully explain why? 

Question 5 of 10

5. What challenges or emotional patterns are you currently hoping to shift or better understand? 

Question 6 of 10

6. If you could change one thing in your inner world or daily life right now, what would it be? 

Question 7 of 10

7. When difficult emotions come up, how do you typically cope or respond? 

Question 8 of 10

8. What kind of support helps you feel safe, grounded, and understood? 
 

Question 9 of 10

9. What feels most important for you to receive support with over the next 12 weeks? 

Question 10 of 10

10. Are you willing to take intentional steps between sessions and actively participate in your healing journey? 

Confirm and Submit