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Application for Faith Over Fear Program

Please complete this form in its entirety in order to be considered for the program. Only 10 slots are available and we want to ensure this is the right fit.

Full Name

Email *

Phone *

Have you ever worked with the Coach or Therapist before?

Yes

Are you a man who is 18 years of age or older?

Yes

Are you a man who is 18 years of age or older?

Anxiety

Stress

Exhaustion

Sleep issues

Confidence

Racing thoughts

Panic attacks

Chest pains

Tremors

Headaches

Upset Stomach

Anger and frustration

Decision-making

Self Doubts and Shame

Faith in God

Isolation

Broken or Difficult Relationships

What’s your major area(s) of concern that you would like to improve with coaching?

Regarding your specific needs, what does success look like for you?

What are some roadblocks standing in the way of this “success”? Remember, roadblocks are not just physical (i.e., time, resources)- Roadblocks are also mindset related (i.e., fear) . No matter what it is, get real about it here.

What have you tried in the past to solve this problem (regarding the areas of concern you listed above)? How effective was it?

If you and Eric determine that working together is a great fit, do you have the funds available to make a significant investment in coaching at this time? If not, what are you willing to do to find the funds you need?

Are you ready and committed to take ACTION, and make changes in my environment, habits and life?

Yes

Maybe

How did you hear about us?

Would you like us to reach out to you by texting you or by emailing you? *

Text

Both

Find Strength in Faith.

[email protected]

(904) 429-8535

7235 Bentley Road, Jacksonville, FL 32256