You’re One Step Closer...

The Narcissistic Abuse Recovery Program Application

Go ahead and submit your details to see if you are a good Candidate for the program!

{Even if you aren't a good match for the program at this moment I will give you Resources, Recommendations, or Referrals to help you progress on your healing journey.}

STEP 1:

Fill In Your Details Below...

Yes, I want to shortcut my success, and I'm interested in one of the spots inside of the Narcissistic Abuse Recovery Program.

This is my confidential application form:

First Name

First Name

Last Name

Last Name

Email Address

Email

Phone Number

Phone

In a few words, how have you been affected by Narcissistic Abuse?

Enter your answer here

Please tell me a little bit about the 'you' before the Narcissistic Abuse

Enter your answer here

Are you currently 'No Contact' with the Narcissist?

If you ticked "Modified Contact", "We are in touch regularly" or "Other", please explain your situation in a few words

"No Contact" is highly recommended so that your nervous system can feel safe enough to do the healing work. I don't require you to be no contact to begin, but it will be needed within 3 sessions of us working together in order to progress.

Enter your answer here

What has been the impact of Narcissistic Abuse on all different aspects of your life?

Enter your answer here

Which of these symptoms are you experiencing?

Anxiety

Please rate on a scale from 0 (not at all) to 10 (all the time)

Depression

Please rate on a scale from 0 (not at all) to 10 (all the time)

Flashbacks

Please rate on a scale from 0 (not at all) to 10 (all the time)

Nightmares

Please rate on a scale from 0 (not at all) to 10 (all the time)

Loss of Identity

Please rate on a scale from 0 (not at all) to 10 (all the time)

Sense of Worthlessness

Please rate on a scale from 0 (not at all) to 10 (all the time)

Difficult to control emotions (such as anger & sadness)

Please rate on a scale from 0 (not at all) to 10 (all the time)

What other symptoms are you experiencing which are not listed?

Enter your answer here

What specific outcomes are most important for you to achieve as a result of attending The Narcissistic Abuse Recovery Program with Amanda?

Enter your answer here

What expectations do you have of both Amanda as your coach and this program?

Enter your answer here

How willing are you to invest in yourself and your own well-being?

I have the time to invest in myself

I have the money to invest in myself (Program is less that 5K with payment plans available)

I can make and keep appointments with myself to work on this

I am fully willing to do the work required to get me where I want to go

I am willing to stop or change the self-defeating behaviors that limit my success

I am willing to try new things even if I am not 100% convinced they will work

I have the patience to take consistent action towards my goals, regardless of how immediate the results are

How important is it for you to heal from this?

Enter your answer here

How committed are you to making this happen?

Enter your answer here

What tools, approaches and methodologies have you explored to recover from Narcissistic Abuse?

Enter your answer here

If you've explored therapy and other intervention methods before, what has been your biggest frustration?

Enter your answer here

Are there any medical conditions or requirements on your part that are likely to affect your capability to participate and/or we would benefit from being aware of? (consent letter from GP may be requested)

If you ticked "yes or Maybe", which condition(s) are you referring to?

Enter your answer here

Have you seen a psychiatrist in the last 12 months?

Enter your answer here

Is there anything else you would like to add to support your application?

Enter your answer here

The Privacy Policy can be found for your reference at www.healingbeyondtrauma.com/privacy-policy

By submitting my application I agree to be added to the mailing list and receive valuable content and special offers relevant to my recovery. I can unsubscribe at any time.

I agree with the terms & conditions (www.healingbeyondtrauma.com/terms-conditions)

I understand that the Coach is a certified Personal Development Coach, Practitioner and Trainer of Neuro-Linguistic Programming, Clinical Hypnotherapist and Hypno-Neurology Specialist, and Somatic Hypnosis Practitioner. I agree to allow her to guide me through any processes relevant for me to achieve the goals you have set.

I know that when entering the Narcissistic Abuse Recovery Program, accountability and responsibility for my results lie with myself. As such you agree that the Coach is not and will not be held liable for any action or inaction, or for any direct or indirect results of any services provided by the Coach.

I acknowledge that results are not guaranteed and are dependent on my commitment.

I am fully aware that Narcissistic Abuse Recovery Coaching does not prevent, cure or treat any mental disorder or medical disease.

I have read and accept the terms & conditions and accept!

Submit My Application