Breakthrough Session Application

Thank you for scheduling your breakthrough session!

During this FREE session, we will have a conversation and see if we are a fit to help you overcome anxiety, depression, and/or bipolar disorder.

Our team is 100% committed to helping you overcome your mental health challenges. Now it is your turn to show us that you’re ready and fighting for your freedom too!

We can serve you best during our session, if you take a moment to answer these simple questions.

We look forward to getting to know you a bit better. Thank you in advance for your vulnerability.

WARNING: Please note that due to the high demand for these limited spots, we may not be able to hold your appointment if we do not receive your application within 24 hours. We give priority to those who are following through.

Name — First

Name — Last

Phone number

We would like to call you to confirm your appointment and relay instructions for preparation.

YouTube Ad

How did you hear about Achieve Emotional Mastery & Staci Rivera Coaching?

YouTube Channel

FaceBook

Guest Appearance

Referral from Graduate

We love our graduates! Which graduate referred you?

Anxiety

Are you currently struggling with anxiety, depression, and/or bipolar disorder?

Depression

Bipolar Disorder

Other

If you checked "other", what other emotional health concerns are you struggling with?

What is your greatest challenge with your mental health right now?

How are you currently managing anxiety, depression, or bipolar symptoms? What tools or remedies are you using, and in what ways do they fall short of your goals?

Tell us a bit about yourself and your specific situation. How has struggling with mental health challenges affected your career and family?

How has your mental health struggles impacted your relationship with God?

What about achieving emotional stability and creating more peace and joy excites you the most?

If we were having this discussion 1 year from today, and you were looking back over that year, what has to have happened in your life, emotionally, physically, and spiritually to be satisfied with your progress?

Why now? What is driving you to make this decision to work with a coach towards your healing TODAY?

Are you willing to put in the work, show up with intention, and take action towards your goal - NO excuses?

At Achieve Emotional Mastery, we tailor our approach to fit your current relationship needs. What is your relationship status?

Married

Engaged to be Married

Committed Relationship (Living Together)

Single (Divorced, Widow, Separated, Never Married)

Please confirm that your significant other will be present for this conversation. (Our studies have shown that healing rates are accelerated by 60% when couples work side by side.)

Yes

I am single.

We appreciate your honesty and letting us know that you do not intend to have your significant other present for this life-changing conversation. We understand that relationships can be complicated. Is there a particular reason your spouse is unable or unwilling to attend?

(Our team is 100% committed to you reaching your healing breakthrough, we will reach out via email/phone to discuss next steps.)

Working with Staci and her team is by APPLICATION ONLY, and there is often a waiting list for space in her coaching room. Please describe WHY you’d be a great fit to work together?

How has struggling

By submitting this application you understand that this is a substantial investment in your future and you are prepared to commit the time and resources to get the results that are possible. How would you best describe your commitment level right now?

Thank you for getting fully prepared for your breakthrough! Is there anything you would like to add?