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13
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1
Name
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First Name
Last Name
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2
Email
*
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example@example.com
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3
What is your age?
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4
Mobile
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5
Which state and city are you from?
*
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6
What are the different roles in your life?
*
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you can choose multiple options
Student
Parent
Teacher
employee/salaried
employer/businessman
freelancer
Home Maker/House wife
Still figuring out life's direction.
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7
Which of the following areas concern you right now?
*
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Physical health
Mental Health
Relationships
Money and Finance
Self growth/Career
Lack of clarity, motivation, passion and energy
Focus
Memory
Confidence
Self worth
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8
Are you experiencing the patterns of failure , frustration, depression, anxiety and stress?
*
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YES
NO
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9
Specify your problem
*
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10
What measures have you taken already in order to sort out your problem? Please specify, if any professional support was taken.
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11
How badly on a scale of 1-10 you want to transform yourself to get the desired life?
*
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where 10 means 100% commitment
10
9
8
7
6
5
4
3
2
1
10
9
8
7
6
5
4
3
2
1
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12
What is your current monthly income?
*
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No Income
25k or less
25k-50k
50k-1 lakh
1 lakh-3 lakh
3 lakh-5lakh
5 lakh -10lakh
10lakh and above
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13
If you get scientifically proven methods and time-tested strategies to transform your current life to desired life to achieve freedom from your problem, how much are you willing to invest in yourself?
*
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Money doesn't matter
50k-1lakh
25k-50k
10k-25k
No I cannot invest
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