APPLICATION

Hey Sis!

I know how hard it was for you to break through guilt to get this far in my application process.

I promise you won’t regret taking this step. You aren’t just here for yourself, you’re here for centuries of women in your family who lacked the awareness, resources, and courage to confront this. If you’re still on board to shake shit up, complete the application below.

You’ll be notified within 24 business hours if you’re a good fit! Be on the lookout for an email from my Admin Team at admin@radicalchangetherapy.org.

Full Name

Email Address

Street Address

Unisex T-Shirt Size

Do you own a business?

Age

Phone Number

City, State & Zip Code

Occupation

Instagram Handle

Introduce yourself to me using as many adjectives as possible.

Tell me more about your relationship with your mom. How long has it been traumatic and in what ways has she hurt and disappointed you the most?

What are the top three impacts your mother-daughter trauma has on your day to day life? Be as specific as possible.

What’s at stake if you don’t recover from mother-daughter trauma?

What do you need most from this program?

What makes you want to work with me specifically?

What self-improvements do you want to experience as a result of this program?

Close your eyes and envision the woman you want to become. Describe her to me in as much detail as possible. What does she look like? Where does she work? Who is she connected to? How does she think, feel, and act?

Although I am a licensed therapist, if you enter this program, our relationship will be coach and client which makes me unable to provide you with counseling, therapy, or crisis support. Since we will be discussing sensitive topics that may require additional processing, the following questions are intended to assess if you might benefit from also working with an individual therapist. If it is determined that you would, my Admin Team can pair you with one of our therapists or provide you with a list of referral options to choose from.

Do you have a therapist who you’ll be working with throughout the course of this program?

If yes, how long have you been in treatment, how often do you meet with your therapist, and when was your last appointment?

Do you have a history of suicidal or homicidal ideations or attempts?

Have you ever been diagnosed with a mental health condition? If so, what diagnosis and when?

Have you ever been committed to a psychiatric facility? If so, when and what was your presenting concern?

Should a medical emergency occur during coaching or you disclose imminent intent to harm yourself or someone else, I am obligated to contact the proper authorities. Please list an emergency contact who you would also like to be notified.

Full Name

Phone Number

Relationship

You understand that the Mother-Daughter Trauma Recovery Accelerator is $997 and are currently in a financial position to invest in your recovery?

Your application has been submitted.