Jasmine Lipska Coaching Contact Form
Hello love!

I am so excited that you are considering undertaking a coaching program for yourself.  

I would love the opportunity to get to know you better and for you to tell me openly and honestly about what you would most like to achieve from working with me as your Coach.

Please answer the below form in as much detail as possible.

Only successful applicants will receive an email response, to ensure that we are an aligned fit. Please only apply if you are serious about coaching and the investment that comes with it.

With love,
Jasmine
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Email *
Your full name: *
Country and Time Zone: *
Age: *
Your Instagram handle
How would you best describe yourself in 5 words? *
Why are you considering coaching? What led to you filling out this form? *
What challenges are you currently facing that you'd like to work through via coaching? *
What do you want to be different in your life? How do you want to feel at the end of your coaching series? *
On a scale of 1-10, 10 being highly satisfied, how would you currently rate these areas in your life? Relationships, Career, Health & Wellbeing, Love & Romance. Please answer below. *
What are 3 main goals/intentions you'd like to achieve through coaching? *
Why in particular would you like to work with Jasmine as your coach? *
What is your average monthly salary/income? *
Which program are you most interested in committing to?  *
How are you feeling about committing to your selected program? *
Were you referred by someone? If so, please add their full name below AND email:
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