Please complete this confidential informative survey so that we can best serve your needs. After you fill out the questionnaire, you will contacted to schedule your session. Please note that Melissa is working with men by referral.

In order to provide the highest level of service, Melissa will assess the information you submit to determine the potential synergy for an empowering Coaching/Client relationship. Sometimes it is necessary to decline provision of services to some prospective clients.

Before submitting this form, please read the FAQs page. The information on this page will answer many of your questions and help you decide whether Your Goddess Coach sessions are right for you. Sessions are held in New York City, by phone, and via Skype for international clients.

Your Email:

Please Confirm Your Email:

First Name:

Last Name:

Daytime Phone:

Evening Phone:

Location and time zone:

What is your gender

What is the greatest challenge in your life right now?

What is your current greatest opportunity?

Where would you like your life to be in 6-12 months?

What are you willing to do to get there?

What is your profession?

Which of these best describe your interest at this time? Check all that apply.

 Finding more of my god/goddess energy Clearing drama from my life Increasing my financial prosperity Receiving spiritual guidance for my life Assessing the health of my current or past relationships Recovering from the loss of a relationship Attracting the right partner Deciding whether to change my job or career Increasing my intuition/psychic ability

Which of the following programs/sessions are you interested in? (See the "Services" section on the website for detailed information.)

 Empathic Clearing Private Intensive Goddess Coaching Program Goddess Reading Financial Guidance Reading Forgiveness Session Relationship Transformation Session Tarot Training

How did you hear about www.YourGoddessCoach.com?

Referred by:

Have you ever worked with a coach or therapist? If so, please describe, and indicate whether you are currently working with someone.

Is there any additional information you would like to provide?

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