Consult Form | Tom Collins

I’m genuinely excited to connect with you and explore how we can activate your inner power to help you achieve transformative results!

Thank you for taking the time to complete this intake form; your responses will allow me to make our consultation as focused and impactful as possible.

Complimentary Consultation Intake Form:

First name

Last name

Phone

What motivated you to schedule this consult?

Are you currently in a relationship? If so, for how long?

In what areas of your life do you feel stuck and/or unfulfilled.

What are three of your biggest concerns you have when it comes to your health?

What specific challenges are you currently facing in your sex life or intimate relationship/s?

Are there any recurring patterns or issues that you'd like to overcome?

How are you sleeping at night?

When you wake up in middle of night what do you do?

How do you feel in the morning when you wake up/start your day?

On a scale of 1- 10, 10 being the highest rate the following questions:

How confident do you feel sexually?

How satisfied are you with your job, career, vocation?

Once you submit, I will text you to schedule our consult

Thanks for submitting!