First Name

Last Name

Phone *

Email *

What are you currently struggling with most in your business, income, or personal growth?

If nothing changes over the next 6–12 months, what will that cost you emotionally, financially, and mentally?

What results are you committed to creating in the next 90 days?

What have you already tried to do, to solve this issue?

Why is now the time for you to make this change?

On a scale of 1–10, how committed are you to investing in yourself to create real change? Why did you choose that number?

What would working with the right mentor / mindset master make possible for you?

Are you willing to be coached, challenged and implement what you learn?

Yes

If we both decide this is a fit, are you financially able and willing to invest in a high-level coaching program?

Yes

Possibly

Why do you believe you are a good fit to work with me specifically?

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