How Can I Serve You?

Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about me?*

InstagramFacebookLinkedInJay Shetty websiteOther
What is your Timezone?
What area(s) in your life would you like to work on?*

RelationshipsCareer and WorkFinancesHealthContributionSpiritualityLiving EnvironmentPanning Your LifeAddictionOther
Anything you would like to add? (Optional)
If you were to grade it on a scale of 1-10, where are you right now and where do you want to be?*

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Anything you would like to add to the previous question? (Optional)
What sort of limiting beliefs do you experience?*
ie. "I never win free things.", "There is never enough.", "Love is not for me.""
Anything you would like to add to the previous question? (Optional)
What are some goals you would like to create in the future?*
ie. Financial stability, Alcohol-free, Marriage and family harmony.
Are you ready to make a commitment to change?*

Not sureMaybeYesLet's DO THIS!
Anything you would like to add to the previous question? (Optional)
How comfortable are you with me asking you personal questions?*

Extremely comfortableVery comfortableSlightly comfortableNot at all comfortable
Anything you would like to add to the previous question? (Optional)
What sort of time frame commitment are ready to work with?*

3 months6 months12 months
Anything you would like to add to the previous question? (Optional)
Are you ready to hear some truths about your situation and how we can work together to implement some change?*

Not reallyA little bitYes but be gentleThe whole truth and nothing but the truth
Anything you would like to add to the previous question? (Optional)
Are you ready for me to challenge you where you are in your life right now?*

Not sureMaybeYesLet's DO THIS!
Anything you would like to add to the previous question? (Optional)
Are you ready to change your life? If so lets set up a 1 hour FREE Discovery Call.*

NoUndecidedYES I'm ready for change!
Anything you would like to add to the previous question? (Optional)
Should be Empty: