Makeda (Get Acquainted Form)

Name * This field is required.

First Name

Last Name

Date of Birth We love celebrating birthdays and certainly would like to celebrate yours with you. When is your birthday?

Date

Email* This field is required.What is the best email to communicate with you?

example@example.com

Marital Status

Married

Widowed

Divorced

Single

Not Sure

How many children do have?If you have no children please enter 0.

Using the emoji below rate the quality of your life today.* This field is required.It is important for you to be honest so an accurate assessment can be made.

Which number best describes the level of stress in your life today?* This field is required.

Pick five things that you re personally tolerating or putting up with in your life at present.* This field is required.

Annoying Ex

Demanding parent/s

Miserable people in your life

Tight shoes

Clutter

Disobedient children

Information you can’t find

Spouse

Boyfriend/s

Girlfriend/s

Annoying co-worker

Overbearing Boss

Finding your purpose is more than finding out what you were created to do, it's finding you. The authentic you that is buried beneath the pain, the circumstances, the fears, and the disappointments. It takes courage, strength, and grace. So congrats on your first bold step to creating change in your life. GOD GOT YOU!

Please check the areas in which you would like to make changes.* This field is required.

My Relationship with God

Forgiveness

My purpose

My gifts/Talents

My Business/Career

Healing

Friends

Self care

Money/Financial Situation

Life Style

Relationship

Other

What are the biggest changes you want to make in your life in the next (3) three months?* This field is required.

What are the biggest changes you want to make in your life over the next (3) three years.* This field is required.

What are the restraining forces keeping you from making these changes?* This field is required.

What is stressing you at this time?* This field is required.

What do you expect to achieve in life as a result of hiring me as your life coach?* This field is required.

What do you most want to achieve for yourself in your life?* This field is required.

What is the hardest thing in your life that you have had to overcome?

Who will be supporting you through this process?

This form must also be signed by a parent/guardian for children seventeen years and under. Services will not be provided unless parental consent is given and the information below is completed.

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian's Email

example@example.com

Parent/Guardian's Phone Number

Area Code

Phone Number

ConsentBy clicking YES below, I give full consent for my child to receive coaching from the Makeda Woman.

YESNO

Parental RequirementsI agree to willingly participate in any required session/s with my child to ensure their success while being coached. I also acknowledge it is my responsibility that my child fulfills every scheduled appointment, and is punctual when doing so.

YESNO