Initial Consultation

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How can Coach Keya help?

Coach Keya, The Soul Coach using Hypnosis, Neuro-Linguistic Programming and Energy Medicine

If you are interested in working with Coach Keya, please fill out the form below. Everything you enter here is ABSOLUTELY Confidential. I look forward to hearing from you. Your responses to each question helps me prepare for our conversation at the “Discover Your Path to a Pain-Free Life Session”.

Maybe you do not feel like writing and would rather speak with a professional. If so then please book your Discovery Session here!

While you are waiting to hear from Coach Keya or have your Discovery Session, you may begin with either of the two DIY (Do-It-Yourself) books available at our store.

Either way I would love to hear from you and help you get your goals.

Until later,

Keya Murthy,
The Soul Coach

For Coach Keya to understand how she can best help you, please fill out the following form to the best of your ability, in all honesty, and with as much detail as possible.
Everything you enter here is COMPLETELY confidential and will not be shared with anyone.

Your Full Name *

Your Email *

Your Phone Number *

Best time to reach you *

Date of Birth *

Time of Birth
Please enter your exact birth time if you know it. If you only know an approximate time, you can enter a range like "between 5am-7am" or "morning", "afternoon", "evening", etc.

Place of Birth

You may be struggling in one or more areas of your life. Please number in the order of urgency.
If something doesn't apply to you, you may leave it blank.

Health
Relationship(s)
Career
Peace of Mind
Other

How long have you been struggling with your challenge(s)? Days, weeks, months, years?

Why are you seeking help with Coach Keya now?

There are many therapists and coaches out there. Why do you feel working with Coach Keya will help you get your desired goal?

You cannot pay money to have your troubles disappear. There is no magic wand that will magically make your challenges dissolve. Working together with Coach Keya and seriously commiting to your personal success will make it better for you and help you get your goals with grace and ease. Besides money you must invest time, space and emotions in your success / goal-getting journey. How seriously invested are you in your own success?

Some cases may require referrals from your doctor and/or medical professional. To help decide if you need any medical referral to work with Coach Keya, please answer the following questions to the best of your ability.

Are you undergoing any medical treatment or taking any medication?
YesNo
[group group-medical]Please list the names of all medications and the reasons you take them.

Please list the name and contact information of your primary care provider.

Please list the names of any specialists you are seeing and the reasons you are seeing them. [/group]

Please leave this field empty.

Thank you for taking the time to fill out the form. Coach Keya will respond to you within three business days to discuss possibilities of working together.
Until later, stay well and take care 🙂

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