Transform Your Life

1
Name
First Name
Last Name
2
Phone Number
Please enter a valid phone number.
3
Email
example@example.com
4
Date of Birth
Date
Year
Month
Day
5
Where did you hear about Coaching with Lanasia Angelina?
Please Select
Please Select
Google/Meta Ads
Instagram
Facebook
TikTok
Past Client/Friend
6
What specific outcomes are you seeking from a coaching relationship?Select all that apply
Clarity of Vision & Direction – I want a clear, actionable plan for my life or business so I know exactly what to focus on daily.
Increased Confidence & Self-Belief – I want to overcome self-doubt and show up as my most confident, authentic self.
Mindset Transformation – I want to shift limiting beliefs, strengthen resilience, and develop a success-oriented mindset.
Income Growth – I want to increase my revenue and consistently hit higher income goals
Business Strategy & Structure – I want systems, processes, and strategies that make my business run efficiently and profitably.
Work-Life Balance – I want to create harmony between my personal life, spiritual life, and business so I can thrive in all areas.
Accountability & Consistency – I want to stay disciplined, follow through, and maintain momentum toward my goals.
Leadership & Influence – I want to grow as a leader, expand my network, and make a greater impact on others.
7
What major obstacles have you encountered that hinder your personal or professional growth?
Fear/Doubt
Lacking Clarity
Lacking Confidence
Lacking Strategy
Mindset
Resources
8
Choose the best answer: On most days I feel...
Excited about my life and future
Discouraged about my life and future
Anxious about my life and future
Stuck and confused about my life and future
9
Are you currently seeing /have you seen a therapist?
YESNO
10
What's your serious monthly budget for coaching at this time?
Please Select
Please Select
less than $500
$500-$1500
$1500-$2500
$2500 or more
11
Before scheduling an official consultation for $149. You will be contacted to further discuss your needs. When is the best time to chat for 10-15 minutes over the phone?
Should be Empty: