Thank you for your interest in…

Mark Waldman’s NeuroCoaching

Very few people need more than 1-3 sessions, whether for personal, relational, or business issues — and you should feel significant benefit in the very first session. Using a very unique mindfulness-based communication strategy, I will personally guide you through a series of evidence-based techniques that can rapidly uncover and transform the underlying issues that are holding you back from reaching your desired goals. Our meeting(s) will be face-to- face using Skype, Facetime, or Zoom.us (using the camera on your computer).

Individual sessions are an hour long and cost $350, and a series of three will cost $900. But if you have financial problems, many of my advanced students and Certified NeuroCoaches have agreed to offer their services at a reduced rate (students: $50-75, certified NeuroCoaches: $75-150). To arrange a session with me or one of my advanced students, fill out the intake form below and click Submit.

IMPORTANT NOTE: If you don’t hear back within 48 hours, send an email to my customer support team: Oriel@MarkRobertWaldman.com

NeuroCoaching Intake Form...

Name *

E-Mail *

Phone Number *

Address *

State / Prov *

Country *

Postal Code *

Age *

Occupation *

Referred by

Which do you prefer?

Feel free to answer only those questions below that you are comfortable sharing with me.

COACHING ITINERARY

What are 3 specific issues you want to immediately address?

What would you like to change most about yourself?

Are you familiar with mindfulness practice or meditation?

WORK

On a scale of 1 to 10 (10 = very), how satisfied do you feel with your current work? *

On a scale of 1 to 10, how satisfied are you with your current income? *

What is your current income?

EMOTIONAL HEALTH AND LIFE SATISFACTION

On average, how much time per day (minutes/hrs) do you feel anxious, worried, or uncertain?

How much time per day (minutes/hrs) do you feel sad, lonely, or depressed?

How much time per day (minutes/hrs) do you feel happy, calm, and satisfied?

What would be the three most traumatic events you’ve experienced in life?

(This question is important because some forms of past trauma and abuse can interfere with current health and achieving desired goals.)

Traumatic event #1

Traumatic event #2

Traumatic event #3

What else would you like to share with me about your life, your goals, your dreams, or your problems?

Note: Face-to-face interaction is essential for doing NeuroCoaching: Invite me on skype (my skype name is markrobertwaldman). Zoom.us is better if you have a poor internet connection. I can send you instructions to set it up on your computer (preferred) or cell phone. We can also use Facetime if the other options don’t work or with Zoom using your computer camera. Looking forward to seeing you soon!

Thanks! Mark

0 + 4 = ?Please prove that you are human by solving the equation *