5 Days to Clarity, Momentum & Confidence

1

Your Full Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Country

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Which statement best describes your current business stage?* This field is required.

Haven’t started yet, but have an idea or passion

Launched a business but not yet earning consistently

Currently earning around $3k/month or less

Earning over $3k/month but feeling stuck or plateaued

Established, but looking to scale beyond $10k/month

6

How long have you been working on your business (or idea)?* This field is required.

0–6 months

6–12 months

1–2 years

Over 2 years

7

What’s your single biggest challenge right now in growing (or starting) your business?* This field is required.e.g. “Attracting clients,” “Building confidence,” “Clarifying my niche,” “Scaling my offers,” "Don't know where to start" etc.

8

Have you tried any strategies, coaching, or courses to overcome this challenge before?* This field is required.e.g. “Attracting clients,” “Building confidence,” “Clarifying my niche,” “Scaling my offers,” etc.

YESNO

9

If yes, which ones, and how did they help (or not help)?

10

Why is achieving success in your business important to you at this stage of your life?* This field is required.Short Answer: A chance to capture personal motivations, e.g. “I want financial freedom,” “I crave purpose,” “I want more time with family.”

11

What’s your ideal monthly revenue goal in the next 6–12 months?* This field is required.

Under $3k

$3k–$5k

$5k–$10k

Above $10k

12

On a scale of 1–5, how important is it for you to fix your current challenge now rather than later?Rating Scale (1 = Not urgent, 5 = Extremely urgent)

13

How willing are you to invest (time, energy, finances) in getting the right support to grow?Rating Scale (1 = Not at all, 5 = Fully committed)

14

What might prevent you from following through on a proven plan?* This field is required.e.g. finances, time, mindset, etc.

15

If you found a program tailored to your needs, how soon would you want to get started?* This field is required.Please Choose One

Immediately

Within 1 month

Within 3 months

I’m just exploring options for the future

16

Where do you see yourself 12 months from now if you had the right strategy and support?* This field is required.Short Answer:

17

Any other specific information you’d like to share about your goals or challenges?* This field is required.

18

Select Your Challenge Start Date* This field is required.💡 Our challenge runs twice a month, every 2nd Saturday. Please select your preferred date from the available options.

Date