Peacock & Paisley Apply for the GYLB Program Yay! Please fill out this form. If it looks like you’re a good fit, I’ll send you an email with a calendar link so we can talk, and at that point we’ll decide if we’ll work together on your healing! Get Your Life Back Program Application Name Email Address Phone Number Can you comfortably afford the $4000 start fee and $1000 per month thereafter for a year? Can you comfortably afford the $4000 start fee and $1000 per month thereafter for a year? yes no How motivated are you? How motivated are you?I'm curiousIt's important to meI am extremly motivated, this is a top priority What do you want to get out of this program? Do you have the time and energy to put into changing your life? Do you have the time and energy to put into changing your life? yes no What else have you tried already? Why didn't it work for you? What level of support do you need? What level of support do you need?lowmediumhigh How did you hear about me? Why do you want to work with me, out of all the other cool coaches? send it on over!