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Complete this before your call.

We’re looking forward to getting to know you better and how Keri can support you in achieving Somatic Success™

Please only fill out this application if you are ready to make a serious committment to your next level.

We will be asking you some detailed questions so take your time completing this pre-work assessment prior to your call with the team.

If it’s a fit, we will invite you into the program that best suits the level of support you need and challenge you to be committed to your transformation in the same way that we are committed to your growth.

Name *

First

Last

Email *

Phone *

What is your biggest challenge in trying to create the ultimate life you desire? *

Hint: Take a look at the last 30 days.

Please rate your fulfillment in the following categories on a scale of 1 - 10

Health *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

Wealth *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

Relationships *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

Briefly describe a typical day in your life, including your schedule, daily responsibilities and other commitments *

Hint: Take a look at the last 30 days.

Can you identify with any of the following?

Anxiety
Unhealthy
Depression
Uncertain
Overwhelm
Mostly happy but something is missing
Lack of support
Feeling alone
Lack of energy
Unattractive
Insecure
Not sure where to start
Unfulfillment
Stress
Lack consistency
Overweight
Chaos
Feeling behind
Tired of being tired
Never a priority to myself or others

When you envision your dream life what does it look like? *

ie: imagine your ideal daily schedule, romantic relationship, finances, overall mental/physical health and body.

What programs have you previously invested in and what was the cost? Please list. *

On a scale of 1 - 10, how committed are you to taking your life to the next level by creating breakthroughs and overcoming the challenges you communicated above? *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

How did you hear about Keri? Name dropping preferred. *

If we determine this is a good fit, would you be interested in our third party funding option to fund the program?

Yes
No

Lastly, is there anything else you would like to share? *

Success Stories

"I can’t thank you enough. You’re a kick ass coach and have a heart of gold....you’re the BEST!!! ♥️♥️♥️"

Heather Hansen

Salon Owner
Cumming, GA

View Transformation

"Thank God for my coach and my group of amazing and supportive women ... just the refresher I needed to reset!"

Krista McElrath

Realtor and Property Manager
Montclair, NJ

"This group program has challenged me to dig deep into emotions that I did not know were there, to transform from the inside"

Courtney Remmey

Lewisburg, PA

"Working with Keri has been one of the absolute delights of my life and I don't say that lightly"

Angelique MacArthur

Lifestyle and Relationship Coach

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Home
About
Speaking
Podcast
Success Stories
Coach with Keri