Accountability Partner Program Interest Form

First name

Last name

Email (general communication and email check-ins)

Phone Number (for texting check ins)

What are you currently struggling with when it comes to follow-through or consistency?

What kind of support would actually help you stay accountable right now? Select all that apply.

What are 1–3 goals or habits you'd like to stay consistent with over the next month?

How do you prefer to be supported?

Soft and nurtured

Direct and focused

A little bit of both

Not sure yet but I'm open

How would you prefer your weekly check-ins?

Email

Text

Either is fine!

I'd pay extra for a weekly phone call/zoom appointment

Before we connect, are there any questions you have for me?

When are you looking to start?

Let's Connect