Looking forward to connect with you. Please take NO MORE THAN 5
MINUTES to answer a few intake questions.
How high is your driving anxiety out of 1000?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"1000 (extremely high)\n750 \n500\n250\n0 (No Anxiety)"}
How long have you had driving anxiety?
{"type":"textarea","name":"preSessionExcited","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item, even if it's just typing in \"Nada\". :)","height":80,"placeholder":"Could this fear have been passed down genealogically? "}
What is ideal realistic outcome you are looking for? (Passing road test, driving freely on highway etc.)
{"type":"textarea","name":"preSessionStuck","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Really? If so, please just proudly declare that you are ON FIRE. :)","height":80,"placeholder":"How eagerly do you want your FREEDOM?"}
How high is your motivation to overcome your driving your driving anxiety?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"100\n75\n50"}
What wouldn't happen if you don't learn to drive with confidence? How will your lifestyle be effected? (emotionally, financially physically and socially)
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"Imagine all the opportunites you will miss or have missed out on?"}
How much you invest to make your driving anxiety to go away completely?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Driving lesosns and failing road test adds up to a lot of money"}
How soon would you like your driving anxiety to disappear?
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"A Few Years\nA Few Months\nA Few Weeks \nNow\nYesterday"}
We sincerely thank you for taking the time to fill out the form. You have taken the first step towards your driving freedom. We will review your questionnaire and connect with you shortly. “What you seek is seeking you.” Rumi
