Language
English (US)
Español
The Thriving Female Entrepreneur Transformational Program Application:
Fill out this form and Dr. LeTa will give you a call at your selected appointment time.
Full Name
*
First Name
Last Name
Confirm Your Phone Number
*
E-mail (Please use the same as you gave for the appointment booking)
*
example@example.com
Did someone refer you to this program? If so, please enter their full name below.
Please Select one
Google or another internet search
Email Campaign
Social Media Post
Friend
Other (Please specify...)
How would you describe yourself? Check all that applies or if other, please describe.
Female Entrepreneur
Author
Coach / Consultant
Speaker
Professional Service Provider
Doctor
Therapist
Nurse
Other Health Care Professional
Online Marketer
Product Based Business
Other
Your business / Personal website? If you don't have one, just skip in the bottom right.
How does feeling stressed, possibly sleep deprived, overwhelmed or on the verge of burnout affect your life at the moment?
I am completely sick and tired of being sick and tired!
I use substances throughout my day and evening to get by.
I've been gaining weight each year...
I have just experienced a major loss...
I start programs but never finish them.
I am experiencing issues but everyone is too.
I'm managing, but if I drop 1 ball....
I'm doing ok. Nothing is a red flag but I know I need to do something about I feel.
I'm actually doing pretty well, but value investing in preventative measures.
None of the above
If you answered "None of the above", please elaborate here.
What will happen if you don't solve your main complaint?
Where do you want to be? What does your heaven look like?
I feel connected to myself, energized and excited about my life and my work.
I feel empowered and grateful that I have changed the direction of my health so I can relax and focus on other areas.
I absolutely LOVE knowing which foods and supplements make me feel amazing!
I feel incredible in my body, I have flexibility and can express myself in the ways I truly desire.
I experience deep, restorative sleep night after night and wake up feeling so refreshed and ready to continue to build my legacy.
What is your biggest obstacle right now to achieving your goal?
I feel as though I have enough time
I feel I don't have enough money to invest in myself
I feel I can keep putting this off because I'm "doing ok"
I feel overwhelmed and not sure where to start
I have tried things, have wasted my precious time and resources and now have developed trust issues with healthcare providers.
Briefly tell us about your current status and what you are doing right now to solve your main complaint?
How long have you been struggling with this problem?
Less than 3 months
Less than 6 months
About a year
For the past few years
It's been 5 years or longer
What would not having this problem mean to you?
If someone asked me to spend 20 minutes a day on self-care, I would...
Know it's what any serious person would do to make sure they are at the top of their game
Would be a little intimated, but with a proven system I would do it because I'm serious about my health and solving this problem
Avoid it at all costs because I feel I don't have 20 minutes to spare right now as I am really pressed for time.
Right now I...
Have the financial resources to invest in my health
Have access to the financial resources to invest in my health
Don't have the financial resources and I'm going to stay where I am
Do you promise to show up for your scheduled appointment ON TIME and DISTRACTION FREE? Please confirm by typing, "Yes I will" in the box below.
Finally, on a scale of 1 to Bruce Lee, how awesome are you?
1
2
3
4
5
Save
Submit
Should be Empty: