Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Initial Intake Survey
Thanks for your interest in accent coaching services! Below are a few questions in order to get us started. Please fill out to the best of your ability, and know that your answers will not be shared with third parties.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your name?
*
Your answer
What is your primary or native language?
*
Your answer
What other languages do you speak?
*
Your answer
When did you begin learning English?
*
Your answer
How comfortable are you speaking at work with colleagues?
Not at all
1
2
3
4
5
No problems
Clear selection
How comfortable are you speaking publicly or with customers?
Not at all
1
2
3
4
5
No problems
Clear selection
What made you interested in accent coaching?
Your answer
Are there any sounds or words that are particularly difficult for you to say?
Your answer
When I'm finished with accent coaching, I want to sound...
Your answer
I am interested in:
*
A FREE phone consultation to learn more
Scheduling an evaluation - I'm ready to do this!
An email with pricing, and then I'll decide
Other:
Required
What is the best way to contact you concerning an evaluation/services?
*
Your answer
Thanks for your interest!
We'll get back to you shortly with information about scheduling an initial evaluation. Alternatively, you can schedule your own now at
https://calendly.com/polyglotaccents/evaluation/
.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kyle Hartzell.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report