Life Coaching
Please complete the questions below to receive your customized quote for life coaching with Dr. Cook. Once submitted, you will receive an email from Dr. Cook with your quote. Hope you'll be able to connect!
* Required
Email address
*
Your email
What's your name?
*
Your answer
How much life coaching do you think you're ready for?
*
None. I'm not really ready yet.
Dipping my toes in. Just checking it out.
I'm sitting at the edge of the pool. Still a little nervous to jump in all the way.
I'm wading in the water. I know I need this.
Let's dive in. It's time and I'm ready.
Please don't make me choose. I'm just interested, ok?
Have you had a life coach before?
*
Yes
No
I've only been up for free advice thus far.
What do you do? (Job/Occupation)
*
Your answer
What do you wish you did?
*
Your answer
Where do you or did you work? (Company)
*
Your answer
I have to wear pants v. I don't have to wear pants (office v. virtual)
*
100% office
100% remote
50/50 office/remote
75/25 - office/remote
75/25 - remote/office
Not employed due to COVID19
I'm a stay-at-home parent so all of the above!
Other:
Give me a goal!
Work/Life Balance
Productivity
Better Habits
Career Path
Relationships
Other:
Clear selection
How motivated were you at the start of 2020?
*
Low
1
2
3
4
5
6
7
8
9
10
High
How motivated are you today?
*
Low
1
2
3
4
5
6
7
8
9
10
High
My life currently...
*
Single
Married
Divorced
Widowed
Having fun
Don't even ask
Prefer not to say
My mind is frazzled because I have
*
1 kiddo
2 kiddos
3 kiddos
I'm officially crazy and have 4+ kiddos
I'm trying!
Kids? No, haha, I get to sleep in.
Other:
For the ones with kiddos, what are their ages?
Your answer
Do you have a goal for yourself this year? If so, what is it?
*
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
