Your Name
Your Partner's Name
Phone Number
Email Address
With whom should I coordinate the logistical details?
— Select —
Myself only
My partner only
Both my partner and myself
A personal assistant or chief of staff (name and email below)
If a personal assistant should be included in correspondence, please provide their name and email:
Which experience feels most aligned with where you and your partner are at this time?
— Select —
One-Day Private Intensive — a focused and immersive day of dedicated work together · starting at $9,500
Weekend Intensive & Curated Experience — the complete three-to-four day transformation, fully curated · starting at $25,000
Destination Intensive — a fully curated experience, shaped around your preferences and set in a destination of your choosing · starting at $55,000
What type of setting would be ideal for you?
— Select —
Private home or villa
Luxury hotel or resort
Boutique private property
Secluded nature retreat
Wellness resort or spa setting
What type of atmosphere would help you feel safe and at ease?
— Select —
Quiet and still, minimal noise and stimulation
Gentle movement and nature woven in
Beachfront / water views
Private and secluded
A mix, I'd like guidance
Is there a particular property, resort, or destination you have in mind?
(a city, resort, or location that resonates with you)
How important is complete discretion to you?
— Select —
Essential — a non-disclosure agreement is required, with no public affiliation and security considerations.
Important — standard privacy measures are sufficient.
Not a significant concern
Do you prefer a local, out-of-state, island or destination setting?
— Select —
Naples
Estero / Marco Island
Elsewhere in Florida
Out of state
Island / destination
Is there a specific place you love or have in mind?
(a city, resort, or spot that feels right to you)
When are you hoping to participate in your private retreat?
— Select —
As soon as possible
Within the next two to four weeks
Within the next 3 months
Are there particular days of the week you prefer?
(e.g. weekdays, Mon-Wed, weekends, flexible)
Is childcare a consideration for these dates?
— Select —
We have support in place; childcare is arranged.
We will need to schedule around childcare
Not applicable
Travel & Accommodations
Your venue, accommodations, meals, travel, and any wellness treatments are arranged and paid separately from your retreat fee, regardless of the option you select below.
How would you prefer your travel and accommodations to be handled? *
— Select —
We will arrange our own travel, lodging, and meals
We would prefer the white-glove concierge experience, all inclusive.
We are undecided at this time
Investment
Your retreat fee encompasses my clinical preparation, the individual intake sessions for both of you, and your face-to-face intensive work together. Should you wish to continue working with me afterward, that is available as a separate engagement, entirely at your discretion.
*Accommodations, meals, travel, and wellness experiences are arranged and paid separately.*
So that I may design an experience aligned with your vision, please share the "all-in" investment you envision — your retreat fee together with your stay, travel, meals, and experiences.
— Select —
$15,000–$25,000
$25,000–$40,000
$40,000–$60,000
$60,000–$100,000
$100,000 and above
The comfortable ceiling for your full experience. *
— Select —
Up to $25,000
Up to $50,000
Up to $75,000
Up to $100,000
$100,000 and beyond — the experience is the priority.
The maximum you would wish your all-in investment to reach.
In your own words, is there anything you would like me to know regarding your vision or your means?
One of my gifts is resourcefulness. Please share what you are envisioning, and I will do my very best to design something as close to that vision as possible — mindful of your finances, and always transparent.
Rank these in order of importance (numbered 1 to 5, with 1 being the top priority): Location, Resort or residence, Food and dining, Travel, Luxury wellness experiences, The depth of the clinical work.
More Information About Your Relationship
Is there a particular issue, event, or recurring pattern you already know we will need to address?
(this will be held in confidence; please share as much or as little as you feel ready to)
What would your ideal experience look like, from beginning to end?
What do you hope to gain from this transformative experience?
Is there anything that would make this experience entirely unsuitable for you?
(a particular setting, style, or non-negotiable)
What Happens Next
We will narrow down availability and preferred dates.
I will send the formal agreement and payment link.
Submit payment and the signed agreement.
I will connect you with my luxury travel concierge, who will work directly with you on all travel and accommodations.
We will schedule an initial session prior to meeting in person.
Once confirmed, your dates are reserved exclusively for you, and I block my calendar in full. You are investing in my preparation, my expertise, my time, and a curated experience designed to support genuine transformation. Payment is non-refundable.
Agreement
By submitting this application, we understand and agree that — owing to the curated nature of this experience and the concierge-style planning involved — payment is due in full at booking and is non-refundable, and that venue, accommodations, meals, travel, and wellness experiences are arranged and paid separately.
Your responses are confidential and used solely to design a safe and aligned experience for you both.
