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Regain Your Core® Coaching Application

Thank You for Your Interest in the Regain Your Core® Coaching Program!

This application helps us understand if this coaching experience is the best to support your journey. Please answer each question openly and with as much detail as possible. Your privacy is respected, and all information shared will be handled with care and confidentiality.

If additional clarification is needed, you may be contacted using the details you provide. Complete applications allow for the most thoughtful consideration.

🕒 Coaching sessions are held weekly on Tuesdays, Wednesdays, or Thursdays between 11 AM–2 PM EST. Before applying, please ensure this window aligns with your availability. If accepted, your session day and time will be emailed before the program begins.

When you are ready, you may start the application below.

Click the button below to start.

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Question 1 of 11

First & Last Name

Question 2 of 11

Telephone & Email

Question 3 of 11

What do you hope to gain from our work together in the Regain Your Core® Coaching Program and why is this important to you right now?

Question 4 of 11

Please share why you believe Regain Your Core® is a good fit for you at this point in your journey. 

Question 5 of 11

What are the main challenges you’re currently facing? 

Question 6 of 11

What strengths, skills, traits, and support systems (e.g., spouse, trusted friend, church, or community) do you have to help you navigate and overcome your current challenges?

Question 7 of 11

Are you currently diagnosed with a severe mental health illness, which includes but is not limited to bipolar disorder, major depression, or post-traumatic stress disorder (PTSD)?

Question 8 of 11

In the past year, have you experienced thoughts of self-harm or suicide, or engaged in self-harm?

Question 9 of 11

Are you currently working with a therapist, counselor, or psychiatrist?

Question 10 of 11

Is there any additional information you'd like to share with us?

Question 11 of 11

Please specify the program you’re applying for. 

A

Group Coaching

B

One-to-One Coaching

Confirm and Submit