Empress Intake Form

Please complete the form below so I can learn a little bit about you, your work, your family and your goals before our first group call!

Please also drop a photo you love of yourself in our group chat for us to shout you out on social media!

Full Name

Email Address

Mailing Address

Instagram

Birth date, time and location

Are you a mom? If yes, tell me a little about your kid(s).

What does work currently look like for you? If you're a mom, did this change once you became a mother?

What is your biggest dream for yourself in the next 6-9 months?

What do you anticipate will be your biggest challenge in achieving your goals?

Why did you join empress & what do you hope to get from this experience?

Anything else you'd like me to know?