Thank You! Your responses will be emailed to the address you supplied. If you indicated you wanted to be contatcted, you can expect a response within 2 business days.

Have a fantastic day!


if(isset($_POST[‘submit’])) {

//assign post data to variables
$question1 = trim($_POST[‘question1’]);
$question2 = trim($_POST[‘question2’]);
$question3 = trim($_POST[‘question3’]);
$question4 = trim($_POST[‘question4’]);
$question5 = trim($_POST[‘question5’]);
$question6 = trim($_POST[‘question6’]);
$question7 = trim($_POST[‘question7’]);
$question8 = trim($_POST[‘question8’]);
$question9 = trim($_POST[‘question9’]);
$question10 = trim($_POST[‘question10’]);
$question11 = trim($_POST[‘question11’]);
$question12 = trim($_POST[‘question12’]);
$question13 = trim($_POST[‘question13’]);
$question14 = trim($_POST[‘question14’]);
$question15 = trim($_POST[‘question15’]);
$question16 = trim($_POST[‘question16’]);
$question17 = trim($_POST[‘question17’]);
$question18 = trim($_POST[‘question18’]);
$question19 = trim($_POST[‘question19’]);
$question20 = trim($_POST[‘question20’]);
$coachgender = trim($_POST[‘coachgender’]);
$share = trim($_POST[‘share’]);
$visitormail = trim($_POST[‘visitormail’]);

}// end isset

if ($_POST[“visitormail”]<>”) {

$ToEmail = ‘’;

$EmailSubject = ”;

$mailheader = “From: “.$_POST[“visitormail”].”rn”;

$mailheader .= “Reply-To: “.$_POST[“visitormail”].”rn”;

$mailheader .= “CC: “.$_POST[“visitormail”].”rn”;

$mailheader .= “Content-type: text/html; charset=iso-8859-1rn”;

$MESSAGE_BODY = “1) I understand that coaching is not therapy, mentoring, advice giving,
counselling or a ‘quick fix’. Coaching is an ongoing discovery process of choice
that takes patience, perseverance, partnership and creativity: “.$_POST[“question1″].”

$MESSAGE_BODY .= “2) I am ready and able to enter into a committed coaching relationship: “.$_POST[“question2″].”

$MESSAGE_BODY .= “3) I want to improve my quality of life: “.$_POST[“question3″].”

$MESSAGE_BODY .= “4) I am open to change, learning and professional development: “.$_POST[“question4″].”

$MESSAGE_BODY .= “5) I am open-minded and can consider new concepts. I will try different ways
of doing things, I realize that for coaching to be successful I will need to look
at life differently and hear new ideas, learn new skills and change certain habits: “.$_POST[“question5″].”

$MESSAGE_BODY .= “6) I am willing and able to take the actions necessary to create the life I want to
live. I accept responsibility for my actions. I acknowledge that my life
will remain the same unless I embrace change and prioritize action: “.$_POST[“question6″].”

$MESSAGE_BODY .= “7) I will do the things that I say I’ll do. If something is difficult for me,
I will discuss it with my coach so we can solve the problem: “.$_POST[“question7″].”

$MESSAGE_BODY .= “8) I am ready and willing to stop or change any negative
thinking patterns or self-defeating behaviours that may be obstacles and
limit my success: “.$_POST[“question8″].”

$MESSAGE_BODY .= “9) I will choose integrity and be open and honest with my coach,
even if it is uncomfortable for me: “.$_POST[“question9″].”

$MESSAGE_BODY .= “10) I am open to receiving feedback without taking it personally
or getting defensive: “.$_POST[“question10″].”

$MESSAGE_BODY .= “11) I am willing, without excuses, to do the work, and I understand that my
coach is there to help me but not to do my work for me: “.$_POST[“question11″].”

$MESSAGE_BODY .= “12) I can be relied upon to be on time for all phone calls or appointments: “.$_POST[“question12″].”

$MESSAGE_BODY .= “13) If I feel I am not getting what I need or expect from my coach,
I will share this and ask for what I want and need: “.$_POST[“question13″].”

$MESSAGE_BODY .= “14) If this is a challenge for me I will work with my coach to set up systems
so I can keep with my commitments: “.$_POST[“question14″].”

$MESSAGE_BODY .= “15) I have goals that I want to achieve: “.$_POST[“question15″].”

$MESSAGE_BODY .= “16) I believe coaching can help me achieve my goals: “.$_POST[“question16″].”

$MESSAGE_BODY .= “17) I will choose to believe that all things are possible: “.$_POST[“question17″].”

$MESSAGE_BODY .= “18) I can be successful at anything I set my mind to achieving because
I am the only one who can choose to make my life better: “.$_POST[“question18″].”

$MESSAGE_BODY .= “19) My coach is my partner and guides me forward to success,
so I succeed, achieve goals and overcome obstacles. I can share credit
for my success with my coach: “.$_POST[“question19″].”

$MESSAGE_BODY .= “20) Coaching is a worthwhile investment. I have prioritized my finances.
I have sufficient funds to pay for my life-changing sessions: “.$_POST[“question20″].”

$MESSAGE_BODY .= “I prefer a: “.$_POST[“coachgender”].”

$MESSAGE_BODY .= “Share your results with LIFECHANGE Executive Coach Jodi Bryant: “.$_POST[“share”].”

$MESSAGE_BODY .= “I am interested in coaching and would like to connect with LIFECHANGE Executive Coach Jodi Bryant for more information: “.$_POST[“connect”].”

$MESSAGE_BODY .= “Please send me a Client Welcome Package so I can begin the process of hiring a coach through LIFECHANGE COACHING: “.$_POST[“welcomepack”].”

mail($ToEmail, $EmailSubject, $MESSAGE_BODY, $mailheader) or die (“Failure”);
print ““;
print ““;

alert(‘Unable to proceed the process. Please check the form again and retry.’); “;

print ““;