Application for Reclaim

The first step back
to yourself starts here.

I read every application personally. Take your time with the questions — your honest answers are what I use to prepare for our conversation.

You will hear from me within 48 hours.

Before You Begin

Here is what to expect.

Apply

Fill out the application honestly. It takes about 10 minutes.

We Talk

If it looks like a fit, I will reach out within 48 hours to schedule a 30-minute conversation.

You Decide

After our conversation you decide if Reclaim is right for you. No pressure. No hard sell.

Tell me about yourself.

There are no right answers here. I am looking for honesty, not impressiveness. The more specific you are, the better I can prepare for our conversation.

Complete your application

First Name

Last Name

Phone Number

How did you hear about Reclaim?

What role or roles have cost you the most — and what has that cost looked like in your actual life?

What has brought you to this point — what made you stop and say 'I need something to change'?

What would it mean for your life if nothing changed in the next year?

What is your biggest hesitation about applying?

Are you currently working with a therapist or mental health professional?

Yes

Is there anything else you want me to know before we speak?

Form submission[]

The first step back
to yourself starts here.

Here is what to expect.

Apply

We Talk

You Decide

Tell me about yourself.

Complete your application

A few quick answers.

Does applying commit me to anything?

What happens after I submit?

What if I am not sure I am ready?

Is there a payment plan?

The first step backto yourself starts here.

Here is what to expect.

Apply

We Talk

You Decide

Tell me about yourself.

Complete your application

A few quick answers.

Does applying commit me to anything?

What happens after I submit?

What if I am not sure I am ready?

Is there a payment plan?

The first step back
to yourself starts here.