Makeda (Get Acquainted Form)

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Makeda (Get Acquainted Form)

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28Questions

1
Name * This field is required.
First Name
Last Name
2
Date of Birth * This field is required.What is your earth day?
Date
Year
Month
Day
3
Email* This field is required.What is the best email to communicate with you?
example@example.com
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Phone Number* This field is required.What is the best phone number to reach you?
Area Code
Phone Number
5
TimeWhat is the best time to communicate with you?
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Hour
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Minutes
PM
AM
PM
6
Marital Status* This field is required.
Married
Widowed
Divorced
Single
Not Sure
7
How many children do have?If you have no children please enter 0.
8
Have you worked with a coach before?* This field is required.
YESNO
9
If you have worked with a coach before, tell us what worked well and what did not?
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10
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.
11
Which number best describes the level of stress in your life today?* This field is required.
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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
13
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!
14
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
15
What are the biggest changes you want to make in your life in the next (3) three months?* This field is required.
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16
What are the biggest changes you want to make in your life over the next (3) three years.* This field is required.
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What are the restraining forces keeping you from making these changes?* This field is required.
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18
What is stressing you at this time?* This field is required.
19
What do you expect to achieve in life as a result of hiring me as your life coach?* This field is required.
20
What do you most want to achieve for yourself in your life?* This field is required.
21
What is the hardest thing in your life that you have had to overcome?
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22
Who will be supporting you through this process?
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23
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.
24
Parent/Guardian's Name
First Name
Last Name
25
Parent/Guardian's Email
example@example.com
26
Parent/Guardian's Phone Number
Area Code
Phone Number
27
ConsentBy clicking YES below, I give full consent for my child to receive coaching from the Makeda Woman.
YESNO
28
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
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