Tell me a little bit about yourself.
{"type":"textarea","name":"__generic7","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Are you neurodivergent? {"type":"radio","name":"__generic","width":20,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}
What are your pronouns? {"type":"text","name":"__generic9","width":25,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Do you have a specific issue that you'd like to work on? If so, what?
{"type":"textarea","name":"__generic8","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Have you ever received life coaching before?
{"type":"radio","name":"__generic2","width":20,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}
On a scale of 1 to 10, how much do you value personal development?
{"type":"radio","name":"__generic3","width":10,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}
On a scale of 1 to 10, how coachable are you?
{"type":"radio","name":"__generic4","width":10,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}
How competent do you feel in setting and achieving goals?
{"type":"radio","name":"__generic","width":20,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5"}
Please use some adjectives to describe your ideal coaching style.
{"type":"textarea","name":"__generic6","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
How did you find out about me?
Choose OneGoogle SearchSocial MediaA Friend Referred MeFlyer{"type":"select","name":"__generic10","width":45,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Choose One\nGoogle Search\nSocial Media\nA Friend Referred Me\nFlyer"}