Private Access Application

Full Name *

Email *

The services provided through The Fear Code™ are educational and experiential in nature.

They are designed to support clarity, awareness, alignment, and personal insight.

This work is not therapy, counseling, medical treatment, diagnosis, or mental health care.
No medical, psychological, legal, or financial advice is provided.

Participation does not establish a therapist-client, doctor-patient, or clinical relationship of any kind.

The Fear Code™ does not promise outcomes, cures, or specific results.
All outcomes are individual and dependent on personal engagement and responsibility.

Clients are encouraged to seek licensed professionals for medical, psychological, legal, or financial concerns.

By participating in this work, you acknowledge that:

You are responsible for your own decisions and actions
You understand this is not a substitute for professional care
You engage voluntarily and at your own discretion

Private work is limited and selective.
Acceptance is not guaranteed.

I understand and agree.

Which best describes you right now? *

Highly successful but internally pressured

Calm externally, noisy internally

Leading well publicly, disconnected privately

At a crossroads and ready for clarity

Have you previously invested in private coaching, consulting, or leadership development? *

Yes

If accepted, are you prepared to invest financially in private work?

Yes

Where does pressure show up most for you right now? *

When fear appears, which happens first? *

Physical sensation

Words / thoughts

Both

Unsure

What are you most tired of managing internally? *

Why is now the right time for this work? *

I understand: *

This is not therapy

This is private internal, nervous system rerouting, fast-results work

Not all applicants are accepted

All of the above

Thank you for filling out the application. We will be in touch via email in a few minutes!