Let’s Get Started Start Here Name * First Name Last Name Pronouns Appreciated, but not required :) Phone * Country (###) ### #### Email * Age * Social Media (if applicable) Website (if applicable) http:// How did you hear about my work? * Social Media Podcast/Blog/Substack Referred by Shantani Moore Referred by someone else Website/Web Search What's your current relationship with stress and nervous system regulation? * Just starting to understand the connection Actively working on it but still struggling Have some tools but inconsistent results Been to clinics/retreats but effects don't last Feel like I've tried everything What's your current annual income? * Under $50k $50k - $100k $100k - $250k $250k+ How is chronic stress and nervous system dysregulation currently impacting your lifestyle? * Select all that apply Affecting decision-making ability Disrupting sleep despite exhaustion Creating tension in important relationships Limiting capacity for high-level work Causing physical symptoms (headaches, digestive issues, etc.) Making it hard to be present with family/loved ones Reducing enjoyment of success and achievements Describe the #1 challenge that you want to resolve in our work together: * What is this challenge currently costing you? * Lost revenue opportunities (missing $5k+ monthly) Working 60+ hours per week Stress affecting health/relationships Can't scale beyond current level Inconsistent/unpredictable income What have you already invested trying to solve this? * Under $1,000 $1,000 - $5,000 $5,000 - $10,000 $10,000+ I have a suite of programs and will point you in the right direction depending on you goals. For the RIGHT solution, what are you willing to invest? * $1,000 - $2,500 $2,500 - $5,000 $5,000 - $10,000 $10,000+ How quickly do you need to see results? * Within 30 days (this is urgent) Within 90 days Within 6 months Just exploring options What's your biggest concern about investing in this work together? * If we did work together, what would have to happen in our first session for you to feel secure in your investment? *
