Private Consultation Form

Please complete the form below so I can understand what you would like help with, confirm this work is the right fit, and prepare for a focused, productive consultation.

YOUR INFORMATION

First Name *

Last Name *

Email Address *

Phone Number *

Location (City, State, and Country)

SESSION PREFERENCE

Are you interested in: *

In-person Bay Area sessions

Online sessions

Either

WHAT YOU WOULD LIKE HELP WITH

What would you most like support with right now?

Which of the following best describes what you are experiencing?

Select all that apply.

Worry and Anxiety

Anger

Sadness and Emotional Heaviness

Confidence and Self-Worth

Fatigue and Sleep issues

Trauma or Phobia

Chronic Pain

Fibromyalgia

Chronic Illness

Weight Management and Emotional Eating

Changing Destructive Habits

Performance and Public Speaking

Social Anxiety

Limiting Beliefs and Internal Blockages

Rumination and Self-Doubt

Decision Making

Other

What result would you love to create through this work?

How long has this issue been affecting you?

Less than 1 month

1 to 6 months

6 to 12 months

1 to 3 years

More than 3 years

Most of my life

LEVEL OF SUPPORT AND INVESTMENT

Private sessions range from a single focused session to a sustained multi-week experience, so that the level of support can match the depth of the change you want to create.

Based on what you have seen of my services, which level of support feels closest to what you are looking for?

Select one. If you are unsure, that is completely fine; select the last option.

Focused Breakthrough Session, $497 (one 90-minute session, one clear issue)

Rapid Transformation Experience, $1,500 (1 to 2 weeks, one issue with depth)

Deep Repatterning Experience, $2,500 (2 to 3 weeks, long-standing or layered patterns)

Elite In-Person Breakthrough Intensive, from $3,750 (Bay Area, concentrated intensive)

Private Transformation Coaching, from $8,500 (8 to 10 weeks, sustained transformation)

I am not sure yet, and I would like guidance on this

What investment range are you prepared to make to solve this? *

Under $500

$500 to $1,500

$1,500 to $3,000

$3,000 to $8,500

$8,500 or more

I am not sure yet

If this consultation confirms that this work is the right fit for you, are you ready to move forward and invest at that level? *

Yes, I am ready to move forward

I need to think it over

Not at this time

READINESS AND FIT

Why is now the right time for change?

On a scale of 1 to 10, how committed are you right now to creating this change? *

1 = not very committed, 10 = fully committed.

How soon would you like to begin this work? *

Immediately

Within 2 to 4 weeks

Within 1 to 3 months

Just exploring for now

Have you worked with hypnosis, NLP, coaching, or similar approaches before?

Yes

A little

Anything else you would like me to know before we speak?

HOW YOU HEARD ABOUT ME

How did you hear about Rami Bareket Transformation & Performance?

Thank you for taking the time to complete this form. I personally read every submission. If it looks like this work is a good fit for what you want to create, you will receive an email and text with a link to book your consultation call. If it does not look like a fit, you will hear back with the most appropriate next step.

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