Coaching Questionnaire

1
Image Field
2
Name* This field is required.
First Name
Last Name
3
Nice to meet you, {name}!

I'm April Fidura and its no mere coincidence that your here; you've arrived at precisely the right moment, indicating you're ready for profound TRANSFORMATION.

There's nothing that fills me with more excitement than collaborating with clients like you to help unveil their dream life and guide them towards reaching their full potential.

Before we embark on this transformative journey together, I'd like to ask you a couple of quick questions. Your honesty in this process is not only appreciated but crucial. Your genuine responses will enable me to provide you with the most effective support.

This questionnaire will serve as the essential foundation for the transformation you're seeking, so let's begin this journey together.
4
What's Your Phone Number?* This field is required.
Area Code
Phone Number
5
What's Your Email Address?* This field is required.
example@example.com
6
How did you hear about me?* This field is required.
Instagram
Facebook
TikTok
Google or Website
Refferal
Other
7
How old are you?* This field is required.Honesty is the best policy.
8
Location* This field is required.City and State where you currently reside.
9
Social Media Handle* This field is required.Personal or business Social Media Handles
10
In what areas are you ready to heal, transform and level up?* This field is required.
Health
Wealth
Relationships
All three
11
On a Scale of 1-5, How confident are you that you know your souls purpose?* This field is required. 1. No idea. 2. Low confidence 3.Neutral 4.Pretty confident 5.Very confident
1
2
3
4
5
12
Have you ever worked with a Professional Coach?Choose from the following 3 options
Please Select
Please Select
Nope! First time.
Yes, I love personal growth.
Does therapy count?
13
Working with a Quality Coach is an investment to your life. If we are a fit are you prepared (mentally and financially) To make that decision for yourself? Coaching programs start at $997
Please Select
Please Select
Yes, I am ready for this journey.
I think so but I have questions
No I don't think I can do that
Other
14
{name}, What is your reason? Your why? What makes you ready NOW to undergo transformation and take on a coach?* This field is required.This is a chance for you to tell me a little more about what's going on in your life and The WHY behind your desire to work with me as a coach, so take a few moments to think through and complete this question.
Huge
Large
Normal
Small
Ok
Ok
15
What do you think is holding you back from growing in your life or career?* This field is required.Select the options that might be concerns or problems.
Work life balance
Time Management
Numbing: Netflix, alcohol, food, etc.
Stress
Mental Health and well being
Relationships: Communication, understanding and relating to others, being anxious or avoidant, etc.
Finances
Lack of Discipline
Lack of Motivation
Anxiety or fear of the unknown
Control
Overthinking
I don't know I need help
Myself
16
Throughout your life, what has proven to be the most challenging obstacle you've faced, and what steps did you take to overcome it?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
17
When you invest in yourself through my program, what do you hope to achieve as your most significant outcome or result?* This field is required.This is your chance to dream into your future. Dream BIG.
Huge
Large
Normal
Small
Ok
Ok
18
Achieving transformation requires dedication and commitment.* This field is required.How much time are you currently able to commit to the process?
100% 2-3 hours per week. Whatever it takes.
1-2 hours per week.
30 minutes?
Good question, I'm not sure.
Other
19
Are you ready to commit to a minimum of six months?* This field is required.Real change does take time, and there are no shortcuts. Are you willing to make a commitment to your personal growth?
YESNO
20
{name}, are you prepared for our 1 hour discovery and connection call?? * This field is required.Let's get to know each other more and see if you're a good fit for Love Mechanism.
YES! I Can't Wait lets schedule our video chat.
No. I am not ready, just inquiring.
Should be Empty: