Burnout Client Intake Form

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Name(Required)

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Email(Required)

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How did you hear about Lora?(Required)

What’s the moment you realized something had to change?(Required)

When you think about what led you here, what unspoken agreements or expectations no longer feel fair or sustainable—and how has that chipped away at your sense of self or what matters most to you?(Required)

Where in your career or life have you stayed silent when you wanted to speak up?(Required)

What are you secretly afraid will happen if you slow down, say no, or put yourself first?(Required)

If nothing changes, where do you think you’ll be six months from now?(Required)

If our coaching journey together was wildly successful, what would be different in your life, your career, and the way you feel about yourself? Paint me the picture—what does success look and feel like for you?(Required)

Select Payment Option(Required)

Starter Session (1 Session) $198.00

Momentum Package (3 Sessions) $535.00

Transformation Package (6 Sessions) $1,010.00

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