What is your reason for filling out this questionnaire? *

I have habits that are hindering my progress

Stress and anxiety are having a negative impact on all areas of my life

I want to identify and overcome the subconscious beliefs and programming that are holding me back from reaching my goals and full potential

I've hit an invisible ceiling on my income or revenue

I want to establish stronger mental, emotional and physical well-being

I want to strengthen and improve the health of my relationships

Other

I am satisfied with my personal and professional growth and progress over the last year? *

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

What area of your life do you want to focus on over the next 3 months? *

Wealth

Health

Relationships

If high-performance mindset coaching is the best solution for you, when are you looking to get started? *

Immediately

In 1-3 months

In 3-6 months

In 6+ months

What is your name? *

First Name

Last Name

What is the best number to text you at? *

Country

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