New Client Registration Form

PLEASE READ THIS ENTIRE SECTION BEFORE COMPLETING THE FORM.

This form is only for women who are ready to hire Jamila for her services.

Congratulations on making the powerful decision to change your life, marriage, and well-being by reaching out to learn more about working with Jamila McMallow!

Jamila McMallow is a Master Coach for happily married High Level Women Executives & Entrepreneurs. She helps her clients completely transform their relationships with themselves, their husbands, and success/money.

If you are a happily married woman over 35, and desire to work closely with Jamila and empower yourself to create an extraordinary life and marriage, then you are in the right place.

If you are not familiar with Jamila or the results you can obtain by working with her, please visit https://coachjamila.com/client-results first and if you have questions send her a private message on LinkedIn, or Instagram.

At this time, Jamila is only accepting a very limited number of new clients. Thus, it is important to complete the following questions honestly and thoroughly so that Jamila has an accurate picture of your challenges and goals.

(No one sentence answers. Do not rush through this part of the process.)

At the bottom of this registration form is an area for you to complete full payment. There are no payment plans. To work with Jamila privately 1:1 is $3,000 per month. Services are rendered month to month. If you are not prepared to pay $3,000 in full at this time, do not complete this registration form.

Your 30-day term with Jamila begins immediately after payment. You will have immediate direct access to Jamila via Viber voice and text messaging service. Within 1-2 business days, you will receive a series of emails explaining all next steps.

Below are very powerful questions that will begin the process of reflection to help you transform your life, marriage, and relationships.

Jamila's transformational work goes deep to the root, so please do not hold anything back in your answers. 😊

**PLEASE NOTE: If you are in a toxic marriage or relationship, Jamila cannot help you. That is not her expertise. She supports women who are already married to good men and the challenges that come within that relationship. Also, if you are under the care of a licensed medical professional and medicated for severe mental or emotional challenges, Jamila is not qualified to help you. Please do not complete this form.

First Name *

Last Name *

Email *

Phone *

How did you learn about Coach Jamila? *

If you chose Other or Friend, please list here

I would love to know more about what you do. Please tell me more about your career/business and the services you provide. *

I want to know more about what's important to you. What are your top 3 accomplishments that you are most proud of? *

I want to understand more about your past. Tell me about your relationship with your father when you were growing up. *

Tell me about your relationship with your mother when you were growing up. *

Tell me about your relationship with money when you were growing up and now as an adult. *

What major childhood experience still affects you today? *

Tell me about your relationship with your husband and how it is affecting your goals. Are there any challenges?

What are the top 3 reasons why you haven't reached your goal(s)?

When did you first become aware that this was a problem? *

What have you already attempted to do to solve this challenge? *

Why do you think it hasn't completely worked? *

Where do you think your life will be in 5 years if you do not make a serious change both personally and professionally? *

It is important to make the 'INTANGIBLE', TANGIBLE. So, if you had to put a dollar amount on it, how much money do you think this has cost you in time, relationship stress, physical health, missed opportunities, productivity, unrealized income, etc. *

If you could snap your fingers and create your dream life right now, what is it that you want for yourself, your life, your relationships, your career/business? *

What personal fears, doubts, and limiting beliefs do you feel are holding you back from what you want? *

Why do you want to work with Jamila? And why NOW? *

When it comes to changing your life and having what you want, are you ready to take full responsibility for where your life is, your thoughts, feelings, and decisions? *

Have you ever worked with a Coach or other Practitioner in the emotional space before? *

What is your Instagram Profile URL?

What is your LinkedIn profile URL?

Why are YOU the right client for Jamila? Share your heart. *

By providing my phone number and email, I agree to receive emails and text messages from Jamila McMallow, Coach Jamila LLC. I have also read and agree to the Terms and Conditions.

Collect Payment *

$ 3000

All payments final. No refunds.