New Client Pre-Screen

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Answer these questions so we can best help you
New Client Prescreening Form

Thank you for considering Lifestyle Therapy & Coaching for your personal and relationship goals. 

As a relationship specialist helping people enjoy personal and relationship success, I'm only accepting clients who are:

  1. Convinced I'm the best fit for them
  2. Prepared to invest the time and finances in treatment.
  3. Are not under the care of another therapist.
  4. Both committed to treatment (if in a relationship)

Please take a moment to complete my pre-screen to ensure you meet my initial qualifications.

I only accept private payment for my services. Most clients budget one to five hours for treatment monthly. My rate ranges from $495 per hour to multiple figures for special programs. Your first session will take 1-2 hours, and the fee is $495.
Creating personal and/or relationship change requires an investment of time. How much time each month can you allocate to your treatment?
What is your financial commitment to treatment?
Will you be under the care of another therapist while seeking treatment?
Are you having marital relationship problems?
Both of us are committed to treatment
I/We are ready to pay the $495 for the assessment session.
I appreciate your interest in Lifestyle Therapy & Coaching. If I can assist you in the future, please don't hesitate to contact me.
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