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Home
About
1-on-1 Coaching
Resources
Vision and Mission
Apply Now
Contact Us
Radical Recovry Coaching Application
Private Zoom coaching with Steve Feldman — faith-based encouragement, structure, accountability, and action. Not therapy. Not medical treatment. Not crisis care.
Application
Fill out the form and we’ll respond promptly.
Contact Information
Name
Company
Phone
City/State
Age
Your Situation
What are you currently struggling with?
How long has this been affecting your life?
Less than 6 months
6–12 months
1–3 years
3–10 years
10+ years
What have you tried before?
What’s the biggest pattern you keep repeating?
Readiness + Responsibility
On a scale of 1–10, how ready are you to change right now? 1 2 3 4 5 6 7 8 9 10
Why is now the time?
In 90 days, what would Break Free + Build Forward look like?
Support + Safety
Are you currently working with a licensed therapist or medical provider?
Yes
No
Are you currently taking prescribed medication related to mental health or addiction?
Yes
No
Are you currently in crisis, feeling unsafe, or considering self-harm?
Yes
No
Coaching Fit
Why do you want to work with Steve / Radical Recovry specifically?
What do you need most right now?
Structure & routine Accountability
Faith & spiritual strength
Breaking addiction patterns
Discipline & consistency
Identity & purpose
Are you willing to be challenged and held accountable?
Yes
No
Coaching Option Interest
Choose option For Coaching
Radical Reset Session (90 minutes)
Radical Accountability Coaching (4 private sessions/month)
90-day Radical RecovRy Intensive (12 coaching sessions)
Availability Preference:
Weekends
Weekday evenings
Agreements
I understand this is coaching, not therapy or medical treatment.
I understand Steve Feldman is not a licensed therapist or medical professional.
I understand I am responsible for my choices and outcomes.
I agree to seek emergency support if I am in crisis.
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