{"type":"text","name":"PhoneNumber","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"
Coachee Initial Intake Form
Full Name: {"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Email: {"type":"text","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Phone Number:
{"type":"text","name":"__generic3","width":100,"value":"","size":"Normal","validation":"TN","validationMessage":"Please enter a number.","placeholder":""}
What inspired you to meet with a coach? {"type":"textarea","name":"__generic4","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What are your current challenges? {"type":"textarea","name":"__generic5","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
If you had a magic wand that could change one area in your life for the better, what would it be? {"type":"textarea","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
How would this make a difference in your life? {"type":"textarea","name":"__generic7","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Do you prefer weekday or weekend for coaching sessions? {"type":"checkbox","name":"__generic8","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Weekday\nWeekend\nEither"}
What time of the day is best for coaching sessions?
{"type":"checkbox","name":"__generic9","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"7am-10am\n10am-2pm\n2pm-5pm\n5pm-8pm\nAny time of the day"}
Do you give us permission to text or call you to set up an exploratory session with a coach?
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo"}
How did you hear about Purposeful Living? {"type":"text","name":"__generic11","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
