Appointment Questionnaire

Start now with a complimentary Meet Your Inner Goddess Session. During this session we’ll talk about your most pressing challenges and how you can resolve them effortlessly through the magic of feminine energy. This form must be completed in its entirety if you would like to be contacted. If you don’t receive a response within two business days, please send an email to contact@yourgoddesscoach.com or call 212.769.6407.  Please note that Melissa is working with men by referral only.

Please note that this complimentary session is a one time offer. If you miss your session, you may schedule a paid Introductory Consultation that can applied to any coaching package within 30 days.

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.

If you are ready to book a Reading or Special Session with Melissa, click here:
Readings • Special Sessions

Your Email:

Please Confirm Your Email:

First Name:

Last Name:

Daytime Phone:

Evening Phone:

Location and time zone:

What is your Gender

Disclaimer:

Melissa may utilize some or all of the following modalities in a session with you (the participant): dialogue, breathwork, intuitive readings, neurolinguistics, body awareness exercises, dance, and guided visualization. Participants are fully clothed throughout the session. The participant agrees and understands that the techniques are taught with respect and integrity, and the participant must also participate in the session in a respectful manner. Melissa does not support any sexual/romantic connection between practitioner and client, as appropriate boundaries are essential for growth and healing.

What coaching programs are you interested in?

 Goddess Coaching - Private Sessions Goddess Coaching Group Coaching for Couples

What special add-on sessions are you interested in?

 Goddess Reading Financial Guidance Reading Tantra Instruction Relationship Transformation Session/Intensive Tarot Training

What is your current greatest relationship or life challenge?

What is your current greatest opportunity?

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

What are you willing to do to get there?

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

 Finding more of my god/goddess energy Creating more love and passion in my relationship Assessing the health of my current or past relationships Recovering from the loss of a relationship Attracting the right partner Receiving spiritual guidance for my life Healing sexual problems Increasing my capacity for pleasure Learning techniques to become a better lover Healing from emotional or sexual abuse

How did you hear about www.YourGoddessCoach.com?

Referred by:

How would you know your Intro Session with Melissa was successful?

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

What times do you prefer for an Intro Session?

 Lunch time Late afternoon Early evening (very limited)

Share and Enjoy:
  • Facebook
  • Twitter
  • LinkedIn
  • StumbleUpon
  • Digg
  • Add to favorites
  • del.icio.us