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Discovery Call Questionnaire

Our trainings are results-driven and hands-on. That is why it is important that you answer the questions on this form as truthful as you possibly can. Your life will transform when you are honest with yourself and honest with us. We will review many of these questions and your answers with you during your scheduled discovery call. We want to work with women who are ready to take control of their life and who are ready to do the work to make that happen. If that is you, please commence in completing this form. 

 

After your completed form is submitted a member of the Dr. Leslie Inspires team will reach out to you to schedule a call.

Click the button below to start.

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Question 1 of 17

What is your level of education?

A

Did not graduate high school

B

Some college

C

Technical college graduate

D

Associates Degree

E

4-year degree

F

Masters degree

G

Doctoral and above

Question 2 of 17

How many boys do you have?

A

1

B

2

C

3

D

4+

Question 3 of 17

How many girls do you have?

A

1

B

2

C

3

D

4 or more

Question 4 of 17

Are you experiencing any of the following because of your son or other family situation?

A

Headaches

B

Sleepless nights

C

Irritability

D

Blood shot eyes

E

Anxiety

F

Financial ruin

G

Problems with your husband/boyfriend

H

On the verge of divorce

I

Can't get or keep a man

J

Feel like you are losing yourself

K

Disappointed

L

Hopeless

M

Betrayal

N

Like something is wrong but you don't know what

O

Can't stop responding to your son's emergencies

P

Frequent phone calls from his school

Q

Depression

R

Other health problems

S

At your wits end and need help

T

Other

Question 5 of 17

Tell how you believe you got in this situation?

Question 6 of 17

Are you married?

A

Yes

B

No

Question 7 of 17

Is your son's father active in his life?

A

Yes

B

No

Question 8 of 17

Is there an active male in your son's life?

A

Yes

B

No

Question 9 of 17

If there is an active male, does your son listen to him?

A

Yes

B

No

Question 10 of 17

What program are you interested in?

A

One of your courses

B

1:1 Coaching

C

Membership Program

D

I don't know yet

Question 11 of 17

How do you believe this program can help you?

Question 12 of 17

What are your expected outcomes as a result of being in this program?

Question 13 of 17

How did you find out about us?

Question 14 of 17

On a scale of 1-10, give your honest assessment of how committed you are  to doing the work that we require for your to get the transformation in your life that you desire.

A

1 (least committed)

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10 (most committed)

Question 15 of 17

Are any of your son's dealing with any emotional or mental health issues?

A

Yes

B

No

Question 16 of 17

Do you have any mental health issues?

A

Yes

B

No

Question 17 of 17

Please provide your email address and phone number.

Confirm and Submit