Which program are you applying for? 

What's your loved one's name, age, and relation to you?

What time zone does your loved one live in? 

We don't need an entire history but if you could tell us a little about the problem, that would be helpful. 

Has your loved one tried other things in the past?  (counseling, treatment, 12-step meetings, other..) Was it helpful? 

What are their top motivators for making this change? 

Have you talked to your loved one about starting recovery coaching?  (What's happening that letting you know that they're ready for this?) 

What outcome are you hoping for?

Why do you think Amber is the right person to help to help your loved one? 

Are you wanting them to start this month or next? 

Amber typically sees clients on Tuesdays and Wednesdays during regular work hours.  Is this going to work for your loved one's schedule?

Anything else we should know? 

We're definitely going to need your help too!  Are you a member of our Family Recovery Membership? If not, are you willing to become a member and participate while your loved one is coming to coaching? 

Your Name, phone number, and email? 

(*please put YOUR info here, you'll have the oppertunity to give us their info in the next question)

Have you had a chance to look over the FAQ's for this program?  

Do you have any questions about the program?