First Name *

Last Name *

Email *

Business Name *

Tell me a bit about you?

Tell me a little about your business?

What has brought you to apply for Remembering HER at this point in your life? (What feels alive, heavy, stuck, or ready to shift?)

What have you already tried to support your growth or healing? (Mindset work, therapy, coaching, healing, retreats, etc.)

Despite the work you’ve done, what still feels unresolved or unmet in your body or life?

How does your body currently let you know when something isn’t right? (Examples: tension, fatigue, anxiety, shutdown, illness, emotional overwhelm, etc.)

When life feels overwhelming, what do you tend to do instinctively? (Push through, withdraw, people-please, overthink, self-abandon, distract, etc.)

Do you feel safe listening to your body right now? Why or why not?

What would it change for you if you trusted yourself fully? (In your relationships, leadership, decisions, or sense of self.)

What feels uncomfortable, scary, or resistant about slowing down and letting your body lead?

Remembering HER is a deep, embodied process not a quick fix. What does commitment mean to you in this season of your life?

How do you currently support yourself when difficult emotions or truths arise?

Are you willing to take full responsibility for your emotional, physical, and energetic wellbeing throughout this journey? YES OR NO

What support systems do you currently have outside of this work? (People, practices, therapy, community, etc.)

Is there anything important you feel I should know about your current physical, mental, or emotional health? (This is not to exclude you it’s to ensure safety and integrity.)

Are you prepared to commit to a 6-month private 1:1 container (time, energy, presence)?YES OR NO

Are you financially resourced for this level of mentorship (upfront or via a payment plan)?YES OR NO

If your body could speak honestly right now, what would it ask for?

I consent to receive communications and understand I can opt-out at anytime.

By submitting this application, I acknowledge that Remembering HER is an embodied mentorship container and not a substitute for medical or psychological care. I understand that this work requires honesty, self-responsibility, and willingness to integrate.