Name
*
First Name
Last Name
There is still a part of us that operates on out dated beliefs and broken habitual patterns. This can cause us procrastinate & feel stuck in developing your dreams into reality. Making it easy to quit on your dreams. I know this, because I've been there. Taking a moment to complete these questions will help you start making the internal changes that are required for you to breakthrough your fears and start moving forward in your dreams.
This is a judgment free zone. Answer these questions without any concern of judgement. The more honest you are, the more I can help you breakthrough your current blocks and move to the next level of success.
Email
*
example@example.com
Back
Next
What is Your Preferred Method to Contact?
*
Phone
Text
Email
Social Media (if so specific which social plat form when giving contact information)
Other
Please Include Contact Information
*
If Social Media Please Leave Platform & Username
Back
Next
When did you decide you wanted to be an entrepreneur?
*
What made you decide to start?
*
Back
Next
Do you still work a 9-5 job?
*
If yes, how bad do you hate it?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
Back
Next
What is the hardest part of entrepreneurship so far?
*
What are you most scared of?
*
Back
Next
What do feel is holding you back the most from taking action ?
*
You've taken action, but have gotten little to no results.
Taken action, no results
Haven't take action
Taken action, but not the results I want.
I don't know what the "f*ck" I am doing.
Back
Next
If you were able to improve by 30% what would that do for you and your business?
*
Back
Next
What do you do when you feel pressure, anxiety, or stress?
*
Back
Next
If you had unlimited time, money, and resources, what would you want to create?
*
Back
Next
Is there anything else you want me to know about you?
Back
Next
On a scale of 1 to 5 how open minded are you when it comes to developing new perspectives, taking small actions, & willing to invest in yourself.
1
2
3
4
5
Very Little
Fully Open!
1 is Very Little, 5 is Fully Open!
Submit
Should be Empty: