Creation Code Coaching Questionnaire

Creation Code

Coaching Questionnaire - Please fill out this form
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Which area are you most interested in having a shift?*

Becoming Your BestIdentifying Unconscious BlocksFreedom from the PastFeeling ConnectedSelf-ExpressionSelf-WorthAll of the AboveOther
Which best describes your current situation?*

I want to reach the next level in my life.I want to change my current circumstances.I have specific challenges leaving me feeling stuck.I need a complete breakthrough.
What do you feel is your main challenge?*
Which best describes your Ideal Outcome regarding the breakthrough you would like to have?*

Achieving my True Potential.No longer affected by day-to-day circumstances.Creating the Life I was meant to have.Finally living my life Free from my PastPeace & Fulfillment
If a mentor with a proven process advised me to invest $1,000 towards creating the life I want most, I would...*

Do it, because I am spending at least that much between my personal life and business right now.Do it, because I have the funds, I know what I need to hit my goals, and I am ready for a better life experience.I would do it, but it would be a challenge affording that right now.I would avoid at all costs because I do not believe my life can change, and I do not want to invest in myself, at all.
How soon are you committed to having a breakthrough?*

Today - I am ready to create my Ideal Life now.Within 30 Days - I am ready. I have a couple of things to do, and then I am ready to start.Within 60 Days - I want to create these changes. I have a few things to take care of before I can start.Within 90 Days - I know I need to do something. I have other commitments to complete first.
Which of the following best describes you?*

I have the funds or credit to invest in creating my Ideal Life.I have access to the funds or credit to invest in creating my Ideal Life.I don't have immediate access to funds or credit, but I am resourceful and willing to do whatever it takes to get the funds required.I do not have access to the funds or credit at all, and I want to keep my life exactly as it is now.
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