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IHE Group Coaching Questionnaire

This questionnaire is to get to know The Inner Healing Experience students.

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Question 1 of 33

First and last name

Question 2 of 33

Sex

A

Female

B

Male

C

Prefer not to say

Question 3 of 33

Age

Question 4 of 33

Race

A

Asian/Asian-American

B

Black/African-American

C

White/Caucasian-American

D

Hispanic/Latino-American

E

Native American

F

Other

G

No Response

Question 5 of 33

Phone number

Question 6 of 33

Mailing Address

Question 7 of 33

T-Shirt Size

Question 8 of 33

Occupation

Question 9 of 33

Education Level: 

A

No formal education

B

Primary education

C

High School or GED

D

Vocational Qualification

E

Bachelor's degree

F

Master's degree

G

Doctorate or higher

Question 10 of 33

Are you a Christian?

A

Yes

B

No

Question 11 of 33

Do you belong to a church?

A

Yes

B

No

Question 12 of 33

If yes, I primarily attend church

A

In-person

B

Online

C

N/A

Question 13 of 33

How active are you in your local church? 

A

Very active

B

Active

C

Moderately active

D

Inactive

E

N/A

Question 14 of 33

Do you serve as a pastor or lay minister in your church? 

A

Yes

B

No

Question 15 of 33

Do you consider yourself to be a Christian leader in a non-church setting?

A

Yes

B

No

Question 16 of 33

If yes, please explain

Question 17 of 33

Are you an entrepreneur or have entrepreneurial aspirations?

A

Yes

B

No

Question 18 of 33

If yes, please explain 

COACHING

Please answer the questions below

Question 20 of 33

How did you hear about the Inner Healing Experience?

(Select all that apply)
A

Facebook

B

Instagram

C

Website

D

Friend

E

Other

Question 21 of 33

Did someone refer you to this group? If so, who?

Question 22 of 33

What made you say “YES” to the Inner Healing Experience? 

 

Question 23 of 33

Have you identified a specific pain point you would like to address?  It is okay if you have not. We can assist you with that. 

A

Yes

B

No

C

Unsure

Question 24 of 33

If yes, please explain. 

Question 25 of 33

How would you define your pain? (select one) 

A

Current Pain (6-12 months)

B

Recent Pain (1-4 years)

C

Old Pain (5+ years)

Question 26 of 33

Have you ever received Pastoral or Christian counseling for this specific pain point? 

A

Yes

B

No

Question 27 of 33

Have you ever received professional/mental health counseling for this specific pain point? 

A

Yes

B

No

Question 28 of 33

On a scale from 0-10 where 0=no pain and 10 = severe suffering, how much pain does this issue cause you? (select only one number 0-10) 

A

1

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10

Question 29 of 33

In what ways has this pain negatively impacted your life? 

Question 30 of 33

What are you hoping for  over the next 30 days? 

Question 31 of 33

What are some pressing questions, issues or concerns in your mind regarding what you’ve been through and/or the healing process ahead? 

Question 32 of 33

How can I begin praying for you today? 

 

THANK YOU!

Thank you for taking the time to complete this survey. I will review this thoroughly and follow-up with you if I have any questions. In the meantime, if you have questions or need anything, please don’t hesitate to contact me at [email protected].

 

Please hit “SUBMIT” below to complete this survey. 

 

Thank you! 

 

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