Thank you for taking a moment to share key details about yourself before we meet. I am excited to connect.

First Name

Last Name

Phone *

Email *

Title (Coach, CEO, Speaker etc.)

Social Media Handle *

If you were referred by a friend, please share their name so we can thank them? (*otherwise put N/A)

What is your #1 long-term desire?

What is the #1 immediate result you want right now?

What is the problem you’ve been needing help to solve? "I struggle the most with....."

What steps have you taken so far to make changes in this area?

What frustrates you the most when dealing with your challenge, that you try to avoid? "If I could have my goal without [blank]....."

What is the #1 belief you think as holding you back? "I just can’t stop thinking that....."

When you are able to get your current goal, what is the #1 thing you want to be able to do? "In a perfect world, I am able to....."

How much have you investment in your professional development last year?

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Are willing + ready to commit the time - energy + financial resources to receiving premium level support in creating results?

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I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.