Apply To Work With Mark | Transformational

Application to Work 1:1 with Mark Burgess

I work with a small number of clients who are ready to reflect on where - and who - they are now, and who are open to experimenting with small changes that might reveal new possibilities. These small steps can offer insight into larger changes that reshape how you live and what life can feel like.

This application helps us both get a sense of whether we’re a good fit for this kind of work. Please answer honestly and in your own words. There are no “right” answers - just responses that help us both see if now is the right time to begin.

Some people work with me once, others over several months - this form helps us understand what kind of support feels right for you at this point in your life.

First name

Last name

Phone

Preferred Contact Method

Phone

Whats App

Message

What’s the main reason you’re seeking support right now?

What do you think is at the heart of the challenge you’re facing?

On a scale of 1–10, how ready do you feel to make changes in your life right now? (1 = Not Ready, 10 = All In)

Do you have the time, energy, and resources to commit to your sessions and follow-through between sessions?

Yes

Are you open to exploring your patterns honestly, and taking ownership of the changes you want to make?

Yes

What would make you feel our work together had been worth it?

Preferred session type: (Online / In-Person / Either)

Do you have a preferred session length? (60 minutes / 90 minutes)

Are there any accessibility or health needs I should be aware of?

Confidentiality & Consent: I understand this is an application process and does not guarantee acceptance. I consent to the collection and secure storage of special category information provided, which will be kept strictly confidential.

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