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1:1 Virtual Coaching Interest Form
with Larneka Lavalais, LPC-S, NCC
Thank you for your interest in coaching with Larneka Lavalais, LPC PLLC!
Please complete the form below to help us understand your goals and find the best coaching plan for you.
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Full Name:
*
Your answer
Email Address:
*
Your answer
Phone Number:
*
Your answer
Preferred Contact Method:
*
Email
Phone
Mail
Required
Which coaching option are you most interested in?
*
Balance Reset Session ($150)
30-Day Balance Reboot ($450)
Monthly Balance Membership ($150 per month)
What are your top 1-3 goals for coaching?
Examples: better work-life balance, improved self-care, time management, setting boundaries, leadership confidence.
*
Your answer
What challenges are currently keeping you from feeling balanced?
Examples: burnout, overworking, stress, guilt, lack of motivation, unclear priorities.
*
Your answer
Have you worked with a coach or therapist before?
(Multiple choice)
*
Yes, a coach
Yes, a therapist
Both
No, this will be my first time
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