Primal Man Project Application

1
Which of these most interests you?* This field is required.Please select one option.
Im looking for a new direction in my career
I'm looking to eliminate negative habits and growth barriers
Im looking for access to a likeminded tribe of high performing men
Finding or redefining my purpose and direction
2
What goals are you hoping this will help you with?* This field is required.Tell us more about what you're aiming for and why so we can better understand if this is right for you. Once you complete your response, move on to the next question.
3
By when would you like to accomplish these goals?* This field is required.Being ambitious is not a bad thing!
4
Do you have experience with any of these modalities already?* This field is required.You can select more than one option or none at all and hit 'Next' to proceed to the next question and continue your application.
Breathwork
Meditation
Psychotherapy
Coaching
Menswork
Plant Medicine
5
Let's be real, what's not working in your life right now?* This field is required.Think about your career path, your relationships, how you spend your time etc.
6
How clear are you on your purpose?* This field is required.Slide the emoji to reflect how fulfilled you feel over all and hit Next to continue.
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
7
What do you currently do for work / career?* This field is required.It's alright to include more than one source here.
8
Which of these best describes you?* This field is required.
Self Employed
Employed Full Time
Employed Part Time
Employed Casual
Currently Unemployed
Retired
9
Would you be able to dedicate at least 5 hours a week to implementing implementing strategies to improve your mindset and life?* This field is required.This means working with coaches, mentors and going to experiences to help you move faster and grow on your journey.
YESNO
10
Would you be willing to invest in yourself financially for the purpose of improving your life?* This field is required.For such things as gaining access to coaching, mentors and experiences to help you move faster and grow on your journey.
YESNO
11
Are you currently experiencing or have you been diagnosed with a significant mental health condition, severe depression, anxiety or suicidal ideation?* This field is required.
YESNO
12
What's your First Name?* This field is required.
13
And your Last Name?* This field is required.
14
Lead Source
15
What's the best email address to reach you?* This field is required.
example@example.com
16
What's your best contact number?* This field is required.Important: We have our headquarters in Australia but aren't limited to any part of the world. In order for us to contact you properly without any hiccups, you'll need to make sure you use the right Country Code for the region you live. For example: If you live in Australia, +61 is your Country Code If you live in New Zealand, +64 is your Country Code Please fill in your contact details below. All of your information is always private.
Country Code (+61 or +64)
Your regular mobile phone number
17
18
If you qualify, you'll be able to book in a personal time to speak to a Jason and the Primal team about creating a plan toward the goals you've laid out here.

Making these sessions available requires a lot of preparation, planning and time on our end. We're trying make sure we're using it properly, to connect with and help as many people as possible. If offered a chance to book a session, could you commit to make the most of it and attend your session on time and distraction free?

Please type in ' Yes I can' on the line below and hit 'submit' to complete your application.

Type your response here to complete the application *
Should be Empty: