Holistic Life Coach Free Consultation

To apply for Life Coaching with Marjorie,
please fill in the following form and press the "Submit " button.

Holistic Coaching is not appropriate for all people or needs and this application will help to determine whether this is a healthy next step.
Holistic Coaching is not counseling or psychotherapy. It is designed to deal with present needs and goals, to build skills,
to remove obstacles to highly effective functioning and to enhance development of the will.

After the application is submitted, a free phone or e-mail consultation is the next step to insure that this process is right for you.

Name:
Address:
City: State: Zip/Postal Code:
Country:
Phone: Email:
Re-enter Email for validation purposes:

Age:	Gender:	Marital Status:	# of Children if any:
What issue has brought you to this website?
How long have you been dealing with this issue?
On a scale of 1 to 10 with 10 being the worst - How severely is this affecting your daily routine?
Have you sought help for this prior to visiting this website? Why or why not??
If yes, what strategies were tried? Did they work? Why or why not??
What goals do you expect to achieve ?

Are you in psychotherapy, counseling or psychiatric therapy at this time? Check button for yes

If so, please check with your practitioner to see if this adjunct work is appropriate at this time.

My practitioner does concur with my decision to “Holistic Life Coaching with Marjorie.” Check button for yes

What questions do you have about
“Holistic Life Coaching with Marjorie”?

When would you like to begin this process?
Do you have access to a computer with a webcam? Check button for yes
Have you used SKYPE or or another type of webcam interface before? Check button for yes
Would you be willing to communicate via SKYPE or another type of webcam interface? Check button for yes
Would you prefer to do your free initial consultation by phone or e-mail? Check button to choose Phone e-mail

If you have any additional questions or concerns that were not addressed in the form,
please send me an email directly. I will be in touch with you within a few days of receipt of your application.

Marjorie Gross

Certified Professional Holistic Life Coach

Life Growth Facilitator

Certified Psychosynthesist

Integrating Mind – Body - Spirit

518-862-1974 ext 95

mhgross@me.com

Free half hour consultation

Marjorie