Thank you for your interest in working with me.

Please complete this form so I can support you better.

Country of residence

Preferred Contact Method: *

Please tell me a bit about yourself.

What are your main priorities right now? *

What would you like to improve in your life? Please select what resonates.

What are you hoping to experience in your life over the next 6 months? *

If you had a magic wand what would you use it for? List the feelings you would experience then. *

What has made you consider working with me? *

Alignment with the right offer.

Have you used 1-on-1 therapy, coaching or mentoring before? *

What condition is your physical health in right now? *

How well do you sleep? Please tick what applies. *

What are your energy levels? Please tick what applies. *

I often feel exhausted upon waking up.

I feel rejuvenated in the morning.

I notice that my energy is drained by the end of the week.

I look forward to weekends and vacations to re-energise.

I am full of life force every day.

How soon are you ready to act towards experiencing positive changes in your life? *

The length of my bespoke 1-on-1 services starts from 1 month. The prices start at US$ 375. Are you ready to invest in yourself? *

Preferred Consultation Dates:

Preferred time (in CET)

Is there anything else you would like me to know? *

I consent to receive SMS or WhatsApp Messages and occasional email communication from Anna Lewczuk. I understand that I am free to inform Anna of my wish to opt out of such communication by replying "unsubscribe" at any time.

Thank you for your answers!

I will be in touch soon.

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