You can always press Enter⏎ to continue
WELCOME
Hi there, please fill out this Self-Assessment Form.
11
Questions
START
1
Full Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Phone Number
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
4
Are you tired of always wanting? Wanting your dream house? Wanting that car? Or, maybe even want financial freedom from your business?
*
This field is required.
Yes, and I am ready to make a change.
Yes, but no matter how hard I work, I just don’t see how this is possible.
Yes, who doesn’t want that? The problem is how.
Previous
Next
Submit
Press
Enter
5
Have you ever wondered why everyone else seems to have everything they ever dreamed of and MORE?
*
This field is required.
I am grateful to have everything I have ever dreamed of, but I want to get to the next level.
Yes, all the time. I read all the books and join all the courses yet nothing seems to move the needle.
I have never been that lucky where everything just happens to me. I always have to struggle.
Previous
Next
Submit
Press
Enter
6
Do you hold the belief that everything you desire in life is already within you?
*
This field is required.
Yes, absolutely.
Sometimes, but I tend to doubt myself.
No, otherwise I would already have it.
Previous
Next
Submit
Press
Enter
7
How do you feel about this statement? You can rearrange your thinking to be aligned with a higher concept of yourself and therefore attract everything you desire into your third-dimensional world.
*
This field is required.
I know this to be true, but sometimes I just have to be reminded.
I have tried to understand this, but I can’t stop worrying about the reality of my life and every day.
I don’t understand the statement.
Previous
Next
Submit
Press
Enter
8
Decision-making is one of the most important skills for success. Finish this statement about your decision-making process.
*
This field is required.
I make quick decisions, and I am confident in making them. They are driven by my intuition and belief that everything is always working out for me. OR I take my time making decisions, but once I have made up my mind I am confident in my decision.
My biggest setback is how much I procrastinate. I understand that this is limiting but I don’t have the luxury to make any wrong decisions.
Making decisions in my life is very hard, I weigh the pros and cons. It takes me a long time.
Previous
Next
Submit
Press
Enter
9
Your self-concept is rooted in this question: “Who do I need to be in order to achieve the next level of myself?” Finish this statement.
*
This field is required.
I am ready to embody my next level self. I am ready to let go and trust my path.
I don’t know who my next level self is, I just know I can’t keep living the way I am now.
I want to embody my next level self, but I am scared, and I don’t know how.
Previous
Next
Submit
Press
Enter
10
Who is your current self? How do you define yourself right now?
*
This field is required.
I am a successful business owner that has big dreams and is ready to make them happen OR I am tired of my corporate life and ready to live my purpose and fulfill my dreams.
I am a stay-at-home individual who wants to be their best self and set an example of excellence for my children.
I am in between jobs and tired of living day-to-day paycheck to paycheck. I know I have a bigger life to live.
Previous
Next
Submit
Press
Enter
11
Do you feel ready to take action to invest in who you need to be? Are you willing to find the resources to make it happen?
Yes, I am ready and have the financial resources to take action. It’s Time!
I am ready but I need help with money, I’m willing to do what it takes!
I’m not working and unable to find the financial resources at this time.
Previous
Next
Submit
Press
Enter
12
Where are you currently at when it comes to investing in your personal growth, spiritual expansion, and manifestation journey?
*
This field is required.
This helps us guide you to the most aligned support for your next level.
I'm all in—I’m seeking the highest level of support, mentorship, and frequency with access to Kathleen’s elite spaces starting at $55,000+.
I'm ready to invest in myself and open to life-changing transformation with programs between $1,000–$15,000.
I'm starting out and prefer to explore free or low-cost ways to raise my energy and stay connected to high-frequency content for now.
Previous
Next
Submit
Press
Enter
13
Assessment Score
Previous
Next
Submit
Press
Enter
14
utm_campaign
Previous
Next
Submit
Press
Enter
15
utm_source
Previous
Next
Submit
Press
Enter
16
utm_medium
Previous
Next
Submit
Press
Enter
17
Get Page URL
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
17
See All
Go Back
Submit