Black Women's Wellness Collective: Free Consultation Form
First name
Last name
Email
City/State
Occupation/Title
Company/Business (if applicable)
What Are You Currently Struggling With Most as a Professional Black Woman?
Imposter Syndrome and Overperformance Pressure
Financial Challenges
Workplace Discrimination and Microaggressions
Supportive Community
Mental Health Stigma and Stress
Health Disparities and Wellness Concerns
Advancement and Leadership Opportunities
Cultural Pressures
Lack of Representation and Isolation
How Are You Currently Addressing Your Wellness Concerns? (Check all that apply.)
I’m not addressing it yet, but I know I need to.
I’ve tried self-care practices, but they haven’t been enough.
I’ve sought professional help (therapy, coaching, etc.), but I’m looking for more targeted support.
I’ve joined communities or support groups, but I’m still feeling overwhelmed.
Other (Please specify):
What Does Success Look Like for You in Terms of Managing Burnout? (Select your top priority.)
Finding time for consistent self-care
Reducing stress and anxiety
Setting clear boundaries
Developing a support system with like-minded women
Reclaiming my energy and joy
Other (Please specify):
What Would Support You Most in Your Journey to Success as a Black Professional Woman or Entrepreneur? (Check all that apply.)
Providing tools to better manage stress and overwhelm
Helping me prioritize my mental and physical health
Building community with other like-minded Black women
Offering personalized coaching to support my goals
Creating accountability for my self-care routine
Other (Please specify): ____________
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