Founder / Executive Concierge IntakeΔ Notify Request DetailsAuthorizationGoal SettingConcierge Intake for Founders & ExecutivesReserve a private 30-minute concierge call for you as a founder or senior executive. A non-refundable $250 booking fee reserves a call within 5 business days. On the call, we’ll clarify fit, urgency, and the fastest path into the STG burnout program. Please complete this form yourself as the founder / executive.Company / OrganizationExecutive NameExecutive TitleExecutive Email Executive Phone (optional)Industry- Select -Professional servicesTechnologyHealthcareFinanceManufacturingNon-profitGovernmentOtherPreviousAuthorizationPrimary goal for this concierge call- Select -Burnout recovery plan for a founder/ownerExecutive burnout / leadership resilience planSupport after a stress-related leave / return-to-workPerformance decline / decision fatigue / overwhelmTeam or organizational burnout (leadership consult)Not sure (please advise)What prompted this request right now?Any immediate risk flags we should know about?- Select -No immediate risk flagsSleep is severely disruptedPanic/anxiety spikesFrequent shutdown/crash daysIrritability/conflict escalating at work or homeSubstance use increasingRecent medical event / evaluationOther (explain below)If 'Other', please explainScheduling Window (Next 5 Business Days)Please provide a scheduling window. If you include multiple options, we can usually find a time faster.Availability in the next 5 business daysScheduling constraints / gatekeeping notesPreviousPayment & ConfirmationPaymentConcierge Consult fee: $250 Includes priority scheduling coordination and a 30-minute consult call. We will schedule the call within 5 business days (subject to availability). The $250 is credited toward the first intake session when booked within 14 days of payment.Concierge Consult FeeFee: $250.00Pay with Card (Stripe) This request is for founders and senior executives booking for themselves. The Concierge Consult includes a 30-minute call scheduled within 5 business days (subject to availability). The $250 concierge fee is credited toward the first intake session if booked within 14 days of payment. This form is not monitored for emergencies. If there is immediate risk, call 911 or local emergency services. I acknowledge the Concierge Consult fee and policies above, and I confirm I am the founder/executive completing this request for myself. Previous Request Concierge Consult
