Quest Prologue (Intake Form)

1

Full Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

Social Media LinksI like to match a face and profile to a name!

5

If you could stand for anything - cause, a message, a movement - what would it be?

6

Why is it important to you to be more courageous?

7

What’s the biggest challenge that you recently overcame?

8

What’s the biggest challenge you’d like to overcome in your life?

9

What tangible result(s) is this holding you back from achieving in your life?

11

Why is it important to you to make a change now with me supporting you, rather than attempting this adventure alone for another 6 months, year, or more?

12

If you qualify for an intro call, to maximize the benefit you receive from our call, do you commit to showing up to the call on time, being in a distraction-free location, and enthusiastic about making real changes in your life?

YESNO

13

The down payment for private mentorship is $3000. If we move forward with our Zoom call and both discover you’re an amazing fit, are you ready and excited to invest in yourself?

YESNO

14

(Optional) What are 1-3 of your favorite books, videogames, or movies of all time?

15