Do I Even Need A Coach?
Complete this form and the team will contact you if you qualify for a consultation
Do I Even Need a Coach?
Take this short survey to see if coaching is right for you at this time?
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
DOB
-
Month
-
Day
Year
Date
Which area do you struggle most or could benefit from if you had support?
goal setting & execution
mindset & emotions management
healing & restoration
self-confidence
balance & fulfillment
health & wellness
purpose & identity
How did you hear about the quiz?
Instagram
Facebook
Google
Email
Event
Advertising
Referral
Other
Provide in greater detail why you chose the option above.
How long has it been since recognizing that you needed support?
Please Select
3-6 months
6 months - 1 year
longer than 1 year
Have you tried any other coaching options
Yes
No
If yes, please explain:
Are you under the care of a physician?
Yes
No
Are you currently seeing a therapist?
Yes
No
Rate your current level of self-awareness?
I am very self-aware
I could be more self-aware
I have a minimal sense of self-awareness
I have no sense of self-awareness
Rate your ability to overcome challenges?
I overcome challenges quite easily
I have a difficult time overcoming challenges
Challenges in my life set me back significantly
Challenges paralyze me
Rate our ability to handle change
I embrace change
I don't like it but I handle it well
I have a difficult time adjusting to change
Change throws my life off track
Rate your relationship with goal setting
I often set goals and follow through
I often set goals but seldom follow through
I have a hard time setting goals for myself
i never set goals for myself
How do you view yourself in comparison to others?
I believe that I am at a greater advantage than others
I believe that I have the same advantages as others
I believe that I have the same advantages as others but don't know how to utilize them
I believe that others have greater advantages than me
How would you describe your outlook on life?
I always see the good in things
I see life as a combination of good and bad
I always find the bad in things
I want to see the good but my experiences make me reluctant
How would you rate fulfillment within your business/career?
I am very fulfilled
I am happy but something is missing
I am unfulfilled
How would you rate fulfillment within your personal relationships?
I am very fulfilled
I am happy but something is missing
I am unfulfilled
Which one of our certified life coaches would you like to contact you for a consultation?
Lanasia Angelina - Mindset Transformation, Goal Setting & Execution - (overcome limiting beliefs and take massive action in the direction of your goals)
Ladajah Jackson - Healing Coach, Licensed Clinical Therapist (heal from the hurt caused by past failures)
Kristy Love - Mindset/Manifestation Coach (helping you to reprogram your mindset and breakup with your limiting beliefs)
Ryon Walker - Wellness Coach
Other
After review of your submission, we will contact you to schedule a virtual consultation. Please share with us the best time and the method by which to reach you for next steps.
Submit
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