Full Name
*
Email
*
Phone
*
How did you hear of us (radial)
*
Friends or family
Doctor or practitioner
Search engine
YouTube
Social media
Magazine or other publication
I'm a client
Other
Who referred you?
Will you be an action taker and do what it takes to reach your child's health and sleep goals?
*
Yes
No
On a scale of 1-5 how ready are you to help your little one sleep and feel better?
*
1 (NOT ready)
2
3
4
5 (I feel 100% ready!)
How dedicated are you to helping your child move into healthy sleep and following through, whatever the effort?
*
1 (Not dedicated)
2
3
4
5 (VERY dedicated!)
Are you willing to change your family's lifestyle (sleep times, bedtime routines, travel habits, AND diet) to experience the change you are desiring?
*
Yes
No
Are you in a position to invest?
*
I have the finances/energy to invest in my child and family's growth, health, and sleep. I am ready to create change now!
I am willing to invest if I believe the program and accountability can deliver results.
I am not in a position where I can invest in my family's growth, health or sleep at this time. I'm just exploring options.
On a scale of 1-5, rate your average stress level from day to day:
*
1 (Everything's chill)
2
3
4
5 (Stressed to the max most of the time)
Does your partner support you?
Yes
Not yet
No
Not applicable
Will you need anyone else involved in the financial decision making? If yes, please note that we require him/her to join our calls.
*
Yes
No
If accepted to our sleep coaching program, how soon are you looking to get started? If you aren’t ready, please just wait and schedule when you can, no worries! We expect those who feel it’s a fit to move forward.
*
I'm ready now!
I'm not quite ready to make a commitment, even if this program seems like a good fit.
Our team has family, business, friends, and other customers just like you. We value their time as much as we value yours. For the call, will you respect our time by being in a place where you are fully present, focused, AND show up on time? Will you only choose a time that works for your schedule?
*
Yes
No
I realize that I am booking a real-time call with coach Myra. I promise to respect her time by showing up for the time I selected.
*
Yes
No
Do you consent to have your Consultation Call recorded for Quality and Training purposes? This is required.
*
Yes
No